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TRANSPORTATION SCIENCES CENTER
ACCIDENT RESEARCH GROUP
Division of Arvin/Calspan
CALSPAN ON-SITE AIR BAG DEPLOYMENT INVESTIGATION
CALSPAN CASE NO. 92-12
VEHICLE - POLICE 1991 FQRILXJP CROWN VICTORIA
LOCATION -«HMH^|A
ACCIDENT DATE - JflM i 1992
Contract No. DTNH22-87-C-27169
Prepared for:
U.S. Department of Transportation
National Highway Traffic Safety Administration
Washington, D.C. 20590
DISCLAIMERS
This document is disseminated under the sponsorship of the
Department of Transportation in the interest of information
exchange. The United States Government assumes no responsibility
for the contents or use thereof.
The opinions, findings, and conclusions expressed in this
publication are those of the authors and not necessarily those of
the National Highway Traffic Safety Administration.
The crash investigation process is an inexact science which
requires that physical evidence such as skid marks, vehicular
damage measurements, and occupant contact points are coupled with
the investigator's expert knowledge and experience of vehicle
dynamics and occupant kinematics in order to determine the pre-
crash, crash, and post-crash movements of involved vehicles and
occupants .
Because each crash is a unique sequence of events, generalized
conclusions cannot be made concerning the crashworthiness
performance of the involved vehicles (s) or their safety systems.
TECHNICAL REPORT STANDARD TITLE PAGE
7. Report No.
92-12
2. Government Accession No.
4. Title and Subtitle
Calspan On-Site Air Bag Deployment Investigation
Vehicle - Police 1 991 Ford LTD Crown Victoria
Location -IB Ifc CA
7. Authorfs)
Accident Research Group
9. Performing Organization Name and Address
Transportation Sciences Center
Accident Research Group
Division of Arvin/Calspan
P.O. Box 400
3. Recipient's Catalog No.
5. Report Date:
1993
6. Performing Organization Code
8. Performing Organization
Report No.
10. Work Unit No.
12. Sponsoring Agency Name and Address
U.S. Department of Transportation
National Highway Traffic Safety Administration
Washington, D.C. 20590
72. Contract or Grant No.
DTNH22-87-C-27169
75. Type of Report and Period Covered
Technical Report
Accident DateJ^|/92
14. Sponsoring Agency Code
15. Supplementary Notes
On-site investigation of a single vehicle roadside departure crash that involved a police 1991 Ford LTD Crown Victoria. The
driver sustained a minor (AIS-1) burn of the left fingers from contact with the inflation module.
16. Abstract
This on-site investigation focused on a single vehicle roadside departure crash that occurred on jBHP^* 1992 * The Accident
Research Group was notified of the crash on 4fl§flfc and ^^^ an on ' site investigation ou^^f/fT A marked police 1991 Ford
LTD Crown Victoria was in pursuit of a speeding vehicle and was traveling on a rural two lane mountainous road at a police
reconstructed speed of 119.1 KPH (74 mph). The vehicle drifted onto the right shoulder and broke traction as it exited a moderate
left curve. The right rear quarter panel area of the vehicle impacted a delineator post located at the outboard edge of the shoulder.
The Crown Victoria subsequently rotated approximately 80? in counterclockwise direction across the travel lanes before departing
the left side of the roadway.
The vehicle became airborne as it exited the shoulder area of the roadway as it traveled down a 45° earth embankment. The
right side passenger compartment area impacted several trees which resulted in severe vehicle damage. As a result of the impacts,
the vehicle's supplemental driver air bag system deployed.
The driver of the vehicle was a 54 year old male, 179.1 cm (70.5') and 99 kg (220 lbs.). He was properly restrained by the
active 3-point lap and shoulder belt system. In response to the lateral impact forces, the driver's upper torso slid out of the manual
shoulder belt and impacted the intruding right upper B-pillar, roof, and roof side rail. As a result, he sustained multiple right rib
fractures with flail chest and hemothorax (AIS-4), multiple fractures of the right upper extremity (AIS-3), and a closed head injury
with brief loss of consciousness (AIS-2). He rebounded across the interior of the vehicle and came to rest with his left hand
pressed against the deflated air bag and the inflation module. The heat retained in the inflator assembly melted the air bag and
produced full thickness burns (AIS-1) of the driver's dorsal left middle, ring, and fifth fingers.
17. Key Words
Roadside departure crash
Right side impacts
Air bag deployment
Inflator temperatures of 300°C (578°F)
Thermal burns of driver's left hand, AIS-1
79. Security Classif. (of this report)
Unclassified
18. Distribution Statement
General Public
20. Security Classif. (of this page)
Unclassified
27. No. of Pages
117
22. Price
11
TABLE OF CONTENTS
Summary
Accident Schematic
Accident Data
Ambience
Highway
Traffic Controls
Vehicle
Vehicle Damage
Supplemental Restraint System
Collision Sequence
Human Factors/Occupant Data
Driver Injuries
Driver Kinematics
Selected Prints
Slide Index
Appendix A
Appendix B
Appendix C
Appendix D
Police Accident Report
Air Bag Supplement
NASS Vehicle Forms
NASS Occupant Forms
Page No,
1
5
7
7
7
8
8
9
14
15
19
20
21
24
56
58
75
82
108
ill
CALSPAN ON-SITE AIR BAG DEPLOYMENT INVESTIGATION
CALSPAN CASE NO. 92-12
VEHICLE - POLICE 1991 FORD CROHN V ICTORIA 4 DR. SEDAN
LOCATION -MV m CA
STJMMARY
The single vehicle roadside departurg crash occurred on a
rural two-lane mountainous road on iMHHHN^F/ 1992 during daylight
hours. The involved vehicle was a marked police 1991 Ford Crown
Victoria, 4 door sedan (V.I.N. : 4^0JHliliiHMW ^ that was equipped
with a supplemental driver's air bag system. The crash occurred as
the vehicle was exiting a moderate left curve with a downgrade of
5.2%. The dry asphalt road surface was 6.6m (21' 9") wide and was
bordered by narrow paved and loose cinder shoulders. A steep
downhill embankment of 45° paralleled the left (south) edge of the
roadway. The posted speed limit was 88 kph (55 mph) .
The driver of the Ford Crown Victoria was on routine patrol
and was traveling in an easterly direction on the state highway.
He entered the parking lot of a local service station and noted a
westbound vehicle traveling at a high rate of speed. The officer
initiated a U-turn and activated the vehicle's emergency equipment
(flashing lights and siren) and pursued the speeding westbound
vehicle. During the pursuit, the driver of the Crown Victoria
entered a moderate left curve at a high rate of speed. The vehicle
drifted wide onto the right (north) shoulder and broke traction as
the driver exited the curve. The right rear quarter panel impacted
a delineator post as the vehicle initiated a counterclockwise yaw.
The Crown Victoria subsequently deposited four-wheel centrifugal
tire mar ks on the road surface as it crossed both travel lanes.
The €NRMNNVNM* Highway Patrol computed an initial speed of 119.1
kph (74 mph) for the vehicle as it exited the curve using the
critical curve formula.
As the vehicle crossed the eastbound travel lane and departed
the left edge of the roadway, it had rotated approximately 8 0° in
a counterclockwise direction. The police documented 82.3m (270 ')
of centrifugal tire marks prior to road departure. During
Calspan's on-site investigation that occurred nearly three months
later, 42.7m (140') of tire marks were still visible on the asphalt
road surface. As the vehicle departed the left (south) edge of the
roadway, the right front fender area impacted and dislodged a steel
delineator post from the cinder and earth shoulder. The vehicle
exited the shoulder area in a near broadside orientation and became
airborne as it traveled over the earth embankment . The frontal
area of the Crown Victoria contacted branches of a large tree that
was located on the embankment 7.62m (25') outboard of the roadedge .
The vehicle continued in a near broadside orientation and pitched
slightly to its right. The upper surface of the right front fender
area of the vehicle impacted a 20.3cm (8") cedar tree that was
located 9.1m (30') outboard of the roadedge. The 3 o'clock
direction of force impact fractured the tree 81.3cm (32") above the
ground and deflected the stump along the vehicle's path of travel.
The right passenger compartment and roof side rail area of the
vehicle subsequently impacted a 25.4cm (10") diameter cedar tree
that was located 2.4m (8") east of the 20.3cm (8") diameter tree
and 8.7m (28 '6") south of the roadedge. At impact the vehicle was
pitched approximately 15-20° to its right which resulted in a non-
horizontal impact force. The impact crushed the side structure of
the vehicle 69.1cm (27.2") at the beltline and 83.8cm (33") at the
right roof side rail. Again, the larger diameter tree fractured
1.9m (6' 3") above the ground and the remaining stump was deflected
to the ground as the vehicle overrode the struck tree.
The Ford Crown Victoria rotated approximately 3 0-4 0° in a
clockwise direction following the latter impact sequence with the
25.4cm (10") tree. The vehicle came to rest facing in a downhill
orientation approximately 6.1m (20') west of the 25.4cm (10") 6.1m
(20') diameter tree. During the crash sequence, the supplemental
driver's air bag system deployed.
The driver of the vehicle was a 54 -year-old male with a stated
height of 179.1cm (70.5") and weight of 99 kg (220 lbs.). He was
properly wearing the active 3 -point lap and shoulder belt system.
Belt usage was supported by driver statements, blood stains on the
upper shoulder belt webbing and by load induced abrasions to the
inner plastic surface of the system's latchplate. There was no
loading evidence on the belt webbing or damage to the active
restraint system. The driver stated that he routinely drove the
Crown Victoria with the seat adjusted to a mid-track position and
the seatback set to the most upright position. He stated that ^ the
tilt steering column was probably adjusted to the center position.
At impact with the trees, the driver was probably out of
position to his right due to the pre-crash rotation of the vehicle
and was further displaced at each tree impact. As the vehicle
impacted the 25.4cm (10") diameter tree, the driver moved laterally
to his right as his upper torso slid out of the manual shoulder
belt webbing, while his pelvic area loaded the lap belt portion of
the 3 -point belt system. His head impacted the intruding
headliner and roof 36. 8-50. 8cm (14.5-20") rearward of the right A-
pillar and 27.9cm (11") above the side rail. The 11.4cm (4.5")
diameter head contact cracked the backer to the headliner and bowed
the roof panel approximately 0.6cm (0.25") outward. As a result of
the contact, the driver sustained a laceration to the top of the
scalp (AIS-1) , a closed head injury with brief loss of
consciousness and residual cognitive deficits (AIS-2) , a non-
displaced fracture of the right zygoma (AIS-2) , a nasal laceration
(AIS-1) , a displaced nasal fracture (AIS-2) , and four dislocated
immediately forward of the right B-pillar. The contact resulted in
a fracture of his right clavicle (AIS-2) . His right forearm
impacted the right roof side rail 20. 3-29, 2cm (8-11.5") rearward of
the right upper A-pillar. The contact was evidenced by tissue
transfers on the headliner fabric that covered the side rail area.
As a result of the side rail contact, the driver sustained a
comminuted fracture of the right radial head (AIS-3) and a fracture
of the right proximal ulna (AIS-2) .
During the driver's lateral trajectory, his right chest area
probably contacted the right upper B-pillar as the vehicle crushed
to maximum engagement . Although no contact evidence was visible to
the plastic jacket covering the B-pillar, the driver sustained
fractures of the right ribs 2-9 with flail chest and right
hemothorax (AIS-4) and a right pulmonary contusion (AIS-3) .
The driver subsequently rebounded across the interior of the
vehicle into the left front seatback and/or the left front door
panel. He sustained a fracture of the spinous process of T 12 from
the probable rebound contact. The supplemental driver's air bag
system deployed during the crash sequence; however, due to the
driver's lateral trajectories, he had minimal involvement with the
bag. He came to rest with his left hand under the upper module
cover flap, pressing against the deployed air bag and the inflation
module. The hot inflation module melted the face of the air bag
and an internal tether strap of the bag at the 10 o'clock position.
The heat was transmitted through the bag which resulted in full
thickness thermal burns of the dorsal aspects of the driver's left
middle, ring, and fifth fingers (AIS-1) . The thermal burns
destroyed the tendons of the fingers and required extensive skin
grafts. The driver came to rest slumped forward over the steering
assembly and bled profusely from the nasal injuries onto the
deflated air bag. He was transported by helicopter to a trauma
center where he was admitted for 24 days for treatment of his
injuries. Currently he has no ability to move the left ring and
fifth fingers due to the extensive burn injury.
During our on-site investigation of this crash, a
representative from TRW (manufacturer of the air bag module) was
present to inspect and dismantle the module assembly. During his
discussion of the deployment process, he stated that the air bag
material, which consists of woven nylon with a neoprene liner, will
not support a flame; however, it does have a melting point of 154-
177° C. (310-350° F.). The inflation module, which is primarily
stainless steel, reaches deployment temperatures of 3 00° C. (578°
F.) and cools slowly due to its isolated, non-vented location.
The melted area of the air bag was located 19.1-26cm (7.5-
10 25") left of center and 8. 3-9. 5cm (3.25-3.75") above the3
horizontal centerline. The 1.3 x 7.0cm (0.5 x 2.75") melted area
of the air bag was located 4. 4 -10. 2cm (1.75-4.0") inboard of the
horizontal centerline. The 1.3 x 7.0cm (0.5 x 2.75") melted area
of the air bag was located 4. 4-10. 2cm (1.75-4.0") inboard of the
peripheral seam. Tissue and blood were visible within the melted
area. The face of the inflator- contained melted fragments of the
bag and an internal tether strap that were pressed against the
inflator by the driver's hand.
An external inspection of the inflator assembly did not yield
evidence of filtering screen burnthrough or separation of the
initiator assembly. The assembly was intact and appeared to have
performed as designed. Due to the nature of the driver's burn
injury and the melting of the bag, it was decided that disassembly
of the inflator was not necessary. The module assembl y was
identified by the following^ alpha/numerical sequences:
AND*
Accident Schematic
Calspan Case No. 92-12
Fractured Tree
10" Diameter
Struck Tree
8" Diameter
Struck Tree
Struck Tree
Branches
f
\ o
y
-^C*#'o 1
L. - -
~-h
-45°
Embankment
Area of Struck Delineator
Paved Shoulder
rr V -
IL
i
i
1
#1 -
5.2%
!
I i
\ \1 I
Cinder Shoulder —
% \\
\
Vehicle
1991 Ford LTD Crown
Victoria Police Vehicle
Paved Shoulder
Cinder Shoulder
h
tf^
V
Scale 1 M =20'
Area of Struck Delineator
/ /
/■ /
/ / o '
/ /
CALSPAN ON-SITE AIR BAG DEPLOYMENT INVESTIGATION
CALSPAN CASE NO. 92-12
VEHICLE - POLICE 1991 FORD CROWN VICTORIA
LOCATION - iHfll CA
ACCIDENT DATA
Location:
City/Township :
Area/Type :
Accident Date/Time :
Investigating Police
Agency :
Accident Type:
Air Bag Vehicle Driver
Injury Severity:
Rural, two lane state route
HHHii CA
Rural /Mountainous
«tt, 1992,
daylight hours
Highway Patrol
Single vehicle roadside
departure, multiple tree
impacts
Severe (AIS-4)
AMBIENCE
Viewing Conditions
Weather :
Precipitation :
Road Surface :
Daylight
Clear
None
Dry
HIGHWAY
Type:
Number of Lanes
Width:
Surface :
Median:
State route
2
21'9"
Asphalt
None
Edge
Vertical Alignment:
Horizontal Alignment:
Traffic Density:
North edge - 1.8cm (6') paved
and loose cinder shoulder
South edge - 2.5m (8'4") paved
and loose cinder shoulder
5.2% grade, negative to the
west
Left curve
Light
TRAFFIC CONTROLS
Signals:
Signs :
Markings :
Speed Limit
None
No pertinent signs
Yellow full barrier
centerlines, solid white
edgelines
88 KPH (55 mph)
VEHICLE
Description :
V.I.N. :
Color:
Odometer :
Engine :
Transmission:
Steering:
Brakes :
1991 Ford Crown Victoria, 4 dr.
sedan, marked police vehicle
2FACP72G5MX (production number
deleted)
Black and white
26, 919 miles
8 cylinder, 5.8 L
4 -speed automatic overdrive,
column mounted transmission
selector lever
Power
Power front disc
Padding ;
Active Restraints:
Automatic Restraints;
Defects:
Tow Status :
Upper, mid, and lower
instrument panel, knee bolster,
soft edged steering wheel rim
and air bag module cover,
sunvisors, adjustable head
restraints, fold-down center
armrest, door panels, door
armrests, headliner
3 -point lap and shoulder belts
in the four outboard seated
positions, center front and
center rear lap belts
Supplemental driver's air bag
system that deployed during the
crash sequence
None
Towed due to damage
VEHICLE DAMAGE
Exterior:
The exterior of the 1991 Ford Crown
Victoria sustained severe damage from
multiple impacts with roadside and off-
road objects. As the vehicle exited a
left curve, it drifted onto the right
shoulder and impacted a delineator with
the right rear quarter panel area. The
impact produced 12.7cm (5") of crush to
the panel that was located 86.4cm (34")
rearward of the right rear axle. The
deformation to the quarter panel began
15.3cm (6") rearward of the referenced
axle and extended 111.8cm (44") to the
rear bumper. The vehicle rotated across
the travel lanes in a counterclockwise
direction and departed the left roadedge
in a near broadside orientation. As the
vehicle departed the roadway, the right
front fender area impacted and dislodged
a steel delineator post from the cinder
and earth shoulder. Paint abrasions were
noted to the fender 20-48cm (8-19")
rearward of the right front axle position
and were vertically orientated on the
fender above the wheel opening. Crush
damage to the area was masked by
subsequent impacts .
Exterior The vehicle exited the left shoulder of
(Cont'd) : the roadway and traveled down an earth
embankment, becoming airborne in a
broadside yaw. The frontal area of the
vehicle contacted overhanging branches of
a large tree that was located 7.6m (25')
outboard of the roadedge . The branches
probably fractured the header panel and
scratched the top surface of the
vehicle's hood.
As the vehicle continued on its
trajectory down the embankment, the front
undercarriage area of the Crown Victoria
impacted the ground which displaced the
frontal structure upward. Push bars were
mounted to the front bumper and frame
area of the vehicle. As a result of the
undercarriage impact and subsequent
contact with small diameter trees on the
embankment, the right side of the front
bumper face was dented 40-52cm (16-20.5")
right of center, to a depth of 1.9cm
(.75") . The lower right push bar bracket
was deformed and displaced 12.7cm (5 n )
laterally to the left. The bumper energy
absorbing devices were compressed 3.2cm
(1.25") on the right side and 1.6cm (.6")
on the left side.
Due to the slope of the embankment, the
broadside trajectory of the vehicle, and
vehicle contact with the ground, the
Crown Victoria began to pitch to its
right. The upper surface of the right
front fender impacted a 2 0.3cm (8")
diameter cedar tree that was located 9 . lm
(30') outboard of the roadedge. The tree
impact damage began on the fender at
bumper level and extended vertically onto
the top of the fender and hood,
indicating a non-horizontal (00-LFMN-3) )
impact force. Direct contact damage
began 4 0.6cm (16") forward of the axle
position and extended 2 0.3cm (8") forward
to the leading edge of the fender. The
vehicle subsequently impacted a small
diameter tree with the right front fender
area. The damage was located 16. 5 -3 0.5cm
(6.5-12") forward of the referenced axle
position and involved 7.6cm (3") of crush
on the lip of the wheel opening. The
10
Exterior impacts fractured the 2 0.3cm (8")
(Cont'd) : diameter tree 81.3cm (32") above ground
level and displaced the stump to the east
as the vehicle overrode the remaining
trunk of the tree. The small diameter
tree was completely uprooted and
displaced from its location on the
embankment .
The Crown Victoria continued to pitch to
its right and subsequently impacted a
25.4cm (10") diameter cedar tree that was
located 2.4m (8') east of the previously
struck 8" diameter tree. The impact
damage extended vertically from the sill
of the vehicle onto the side rail and
roof. Due to the slope of the embankment
and the vehicle's attitude at impact, the
damage was diagonally orientated on the
right passenger compartment area. Direct
contact damage on the right front door
and sill area began 111.8cm (44")
rearward of the right front axle and
extended 35.6cm (14") rearward. The
direct contact damage on the right roof
side rail began 162.6cm (64") rearward of
the axle position and extended 33cm (13")
rearward. Maximum crush was 83.8cm (33")
located on the right roof side rail at
the B-pillar. Crush values at the side
rail level were as follows:
C x = 39.4cm (15.5"), C 2 = 78.1cm
(30.75"), C 3 = 83.8cm (33"), and
C 4 = 33.3cm (13.1") at the right A-pillar.
A second set of crush values were
documented at the beltline area of the
vehicle which extended from the A- to the
C-pillars and were as follows:
Cj = 20.3cm (8") , C2 =
= 76.7cm (30.2", C 4 =
20.5cm (8.1") , C 6 = 10.
crush at the beltline
located at the B-pillar. The crush
profile of the right sill area was also
documented and was as follows:
Cj = 0cm, C 2 = 26.9cm (10.6"),
C 3 = 38.1cm (15"), C 4 = 50.8cm (20"),
C 5 = 54cm (21.25"), C 6 = 19.1cm (7.5").
As a result of the multiple impacts, all
exterior sheetmetal components were
11
48.
. 5cm
(19
.1")
/
C 3
50.
8 cm
{20'
'),
c 5
=
2cm (4"
') -
Maximum
was
76.
7 cm
(30
.2
")
Exterior
(Cont'd) ;
damaged from either direct contact or
induced buckling. The left front door
was jammed closed due to the deformation
to the vehicle. Rescue personnel used
emergency equipment to pry open the door
and subsequently cut the hinges to remove
the door from the vehicle. The left rear
door was jammed closed and again, rescue
workers pried the door open to treat the
injured driver. The right side doors
were jammed due to the severe deformation
to the passenger compartment area. All
glazing was damaged by the impacts with
the exception of the left rear door
glazing and its quarter window. The
windshield was removed by rescue
personnel during extrication of the
driver.
CDC;
Event Number
Repair
Cost :
1
12-RBEW-l
2
02-RFEN-l
3
00-FDMW-3
4
03-FZLS-l
5
00-RFEN-3
6
00-RFEN-2
7
OO-RPAN-5
Total
loss
Object Contacted
Delineator post
Delineator post
Tree branches
Small diameter tree
20.3cm (8") diameter tree
Small diameter tree
50.8cm (10") diameter
tree
12
Interior: The interior of the Ford Crown Victoria was
severely damaged as a result of exterior
deformation and driver contact. The right
passenger side impact with the 50.8cm (10")
diameter tree produced severe intrusion of the
right side components. Maximum intrusion
involved 83.8cm (33") of lateral displacement
of the right roof side rail, the roof and the
upper B-pillar at the side rail juncture. Due
to the severe lateral displacement of the side
rail, the roof was crushed to a near vertical
surface on the interior of the vehicle. The
mid right B-pillar and right front door panel
intruded into the center front occupant space,
resulting in a lateral displacement of 76.7cm
(30.2") .
The driver of the vehicle moved laterally to
the right in response to the right side tree
impacts. His knees and lower legs initially
contacted the fuse box cover and the knee
bolster. The fuse box cover was scuffed 53-
61cm (21-24") left of center and 41-46cm (16-
18") below the top surface of the instrument
panel. A lower leg scuff was noted to the
bolster 39-46cm (15.5-18.3") left of center
and 38-43cm (15-17") below the upper panel.
The driver's right knee contacted the
protrusion of the bolster at the base of the
steering column. A scuff mark and disruption
of the vinyl covering was noted 38-46cm (15-
18") left of center. The lateral aspect of
the driver's right knee contacted the center
mid instrument panel (scuff) and the center
mounted police radio equipment. Although the
radios were removed prior to our inspection of
the vehicle, a deformed bracket was found in
the vehicle, indicating contact to the
components .
The driver's head and facial areas impacted
the intruding vertical surface of the roof.
The 11.4cm (4.5") diameter contact cracked the
backer panel to the headliner and bowed the
roof panel outward .6cm (.25"). The contact
point was located 38-51cm (15-20") rearward of
the A-pillar and 22-34cm (8.8-13.3") above the
roof side rail. His right forearm impacted
the right siderail 20-29cm (8-11.5") rearward
of the A-pillar, depositing tissue transfers
on the fabric covering. The driver's thoracic
area contacted the B-pillar; however, no
13
Interior evidence of contact was visible on the vinyl
(Cont'd) : covering.
As the driver responded to the lateral impact
forces, his upper torso slid out of the manual
shoulder belt webbing. His pelvic area
subsequently loaded the lap belt webbing which
pulled the webbing against the crossbar on the
latchplate. The webbing abraded the plastic
coating on the crossbar on the back side of
the component .
SUPPLEMENTAL RESTRAINT SYSTEM
The 1991 Ford LTD Crown Victoria was equipped with a
supplemental driver's air bag system that deployed during the
multiple impact, off -road crash sequence. The module cover opened
in the conventional H- configuration at the designated tear points.
The large upper flap measured 20.3cm (8") in width x 12.4cm
(4.875") # while the lower flap had respective measurements of
20.3cm (8") x 3.8cm (1.5") . The air bag was constructed of a woven
nylon fabric with a neoprene liner and measured approximately 61cm
(24") in diameter (seam-to-seam) in its deflated state. Two 2.5cm
(1" ) diameter venting ports were located on the back side of the
air bag (side away from driver) at the 2 and 8 o'clock positions.
The bag was tethered by four internal tether straps that were sewn
to the center face of the bag in a 17.8cm (7") diamet er pattern
with three rows of orange stitching. Members of the 4RHHHHHH 1
Highway Patrol's Multi-Disciplinary Accident Investigation Team
(M.A.I.T.) properly removed the deployed air bag module from the
involved patrol vehicle.
The upper center portion of the air bag was heavily stained by.
blood from the driver as he came to rest slumped against the
deflated air bag. His left hand came to rest under the upper
module flap and was pressed against the air bag and the inflator
housing. As a result of contact with the hot inflator housing, the
heat was transmitted through the bag which subsequently burned the
dorsal surface of his left middle, ring, and fifth fingers. The
contact also melted the face of the bag at the 9:30 o'clock
position. The melted area measured 1.3 x 7.0cm (0.5 x 2.75") and
was horizontally located 8. 3 -9. 5cm (3.25-3.75") above the mid point
of the bag and 19.1-26cm (7.5-10.25") left of the vertical
centerline. The melted area was also located 4. 4-10. 2cm (1.75-
4.0") inboard and toward the driver from the peripheral seam. Upon
magnification of the melted area, tissue fragments and blood were
found fused to the nylon fabric.
During Calspan's on-site investigation, a representative from
TRW (the company that manufactured the air bag module assembly) was
present to inspect and dismantle the deployed module assembly for
14
possible defects. Numerous members of the 4M|IINMNNfti Highway
Patrol were also present. The TRW representative thoroughly
discussed the deployment process of the module and used several
models to identify the internal components. During his discussion,
he stated that the air bag fabric had a melting point of 154-177°
C (310-350° F) and that the nylon/neoprene material would not
support a flame. The inflator housing and its internal filtering
screens were manufactured from stainless steel . The TRW
representative stated that the inflator module reaches deployment
temperatures of 300° C (578° F) and cools slowly due to its
isolated, non-vented location within the steering assembly.
The module assembly was transported to a state operated
laboratory where a machinist drilled and removed the twelve (12)
retaining rivits that attached the air bag and inflator module to
the stamped mounting bracket. The air bag and the exterior of the
inflator module were thoroughly inspected. The internal surface of
the air bag and a tether strap were melted from contact with the
hot inflator module. The face of the inflator module above the
radial inflation ports contained deposits of melted neoprene and
woven nylon air bag material. These melted transfers, in
combination with the melted air bag which contained tissue and
blood deposits, confirmed the source of the burns to the driver's
left hand. Additional exterior inspection of the inflator assembly
did not yield evidence of component failure. There was no damage
or burn- through of the module or filtering screens; therefore, it
was agreed upon that further dismantling of the inflator assembly
was not necessary. The involved air bag module was identified by
the following bar-coded numbers that were affixed to the back side
of the mQunting bracket:
id
COLLISION
SEQUENCE
Pre -Crash:
The driver of the marked police 1991 Ford
LTD Crown Victoria was on routine patrol
and was exiting a parking lot of a local
service station to proceed in an easterly
direction on the mountainous two- lane
state route. As he was about to exit the
parking lot, he observed a westbound
vehicle traveling at a high rate of
speed. The driver activated the
vehicle's emergency equipment (flashing
lights and siren) and initiated a U-turn
to pursue the westbound vehicle.
During the pursuit, the driver of the
Crown Victoria had negotiated a moderate
left curve; however, as the vehicle
exited the curve, it drifted wide onto
15
the right (north) shoulder. Based on the
physical evidence at the crash scene, the
driver initiated a counterclockwise
steering input and braked in an attempt
to maintain control of the vehicle. The
right side tires of the vehicle departed
the paved right shoulder onto the loose
cinder material that bordered the
shoulder. As a result the vehicle broke
traction and initiated a counterclockwise
yaw. The right rear quarter panel
impacted a delineator post that was
located at the edge of the shoulder. The
minor severity impact did not alter the
trajectory of the vehicle as it crossed
the travel lanes. The vehicle deposited
four wheel centrifugal tire marks on the
asphalt road surface. The investigating
officer documented approximately 76.2m
(250') of centrifugal tire marks prior to
the vehicle crossing the left (south)
white edgeline. At the time of our
inspection of the crash scene, which
occurred nearly 3 months after the crash,
42.7m (140') of tire marks were still
visible on the asphalt road surface. As
the vehicle crossed the south (left)
edgeline of the roadway, it had rotated
approximately 8 0° in a CCW direction.
The HNNHHMNHlte Highway Patrol computed an
initial speed of 119.1 KPH (74 mph) for
the vehicle as it exited the curve, using
the critical curve formula.
Crash: The right front fender of the Crown
Victoria impacted and dislodged a steel
delineator post from the cinder and earth
south shoulder. The impact resulted in
minor damage to the vehicle and produced
an impact force of 2 o'clock. Again, the
minor severity impact with the delineator
did not alter the trajectory of the
vehicle .
The Crown Victoria exited the shoulder
area in a near-broadside orientation and
became airborne as it traversed an earth
embankment that paralleled the roadway.
The embankment had a negative slope of
approximately 45°. As the vehicle
16
traveled down the embankment, the frontal
and hood areas contacted overhanging tree
branches from a tree that was located
7.6m (25') outboard of the roadedge . The
impact produced minor damage to the
vehicle as it continued on a broadside
trajectory. The front bumper and right
push bumper bar impacted several small
diameter trees as the undercarriage
subsequently contacted the ground, which
displaced the front structure upward.
The vehicle began to pitch to its right
as its center of gravity continued in a
southwesterly direction. The upper
surface of the right front fender and
hood impacted a 2 0.3cm (8") diameter tree
that was located 9.1m (30') outboard of
the roadedge. At impact with the tree,
the vehicle had traveled approximately
23m (75') along the embankment. Due to
the lateral pitching of the vehicle, the
resultant direction of force was non-
horizontal (00 o'clock). The vehicle
fractured the tree 81.3cm (32 ") above
ground level and overrode the remaining
trunk, displacing the roots of the tree.
The right passenger compartment area of
the vehicle subsequently impacted a
25.4cm (10") diameter cedar tree that was
located 2.4m (8') east of the struck
2 0.3cm (8") diameter tree. At impact
with the tree, the vehicle was pitched
slightly to its right and struck the tree
with its right roof, siderail, door and
sill areas. Maximum crush was 83.8cm
(33 " ) located on the siderail at the B-
pillar area. Again, the vehicle
fractured the 25.4cm (10") diameter tree
1.9m ( 6 ' 3 " ) above the ground and
deflected the remaining stump to the east
as it overrode the tree trunk. The force
of the impact hurled the upper portion of
the tree into a wooded area where it came
to rest 6.1m (20') to the east of its
struck location.
The supplemental driver's air bag system
deployed during the multiple impact crash
sequence. Although unconfirmed, the SRS
probably deployed early in the sequence
17
as the front bumper and undercarriage
impacted the ground and several small
diameter trees. All impacts involved
force directions that were primarily
lateral (within the 2-3 o'clock sector)
and estimated velocity changes that were
equivalent to the required threshold of
13-19 KPH (8-12 mph) necessary for
deployment .
Post-Crash:
Final
Rest -
Driver
Activities
The Ford Crown Victoria came to rest on
its wheels at the base of the embankment,
facing in a southerly direction. At rest
the vehicle was approximately 6.1m (20')
east of the struck 25.4cm (10") diameter
tree. Due to the slope of the
embankment, the vehicle was barely
visible from the roadway.
The driver lost consciousness as a result
of a head impact with the intruding roof.
He slumped forward over the steering
assembly and came to rest with his left
hand against the air bag inflation
module. Passing motorists noted the dust
in the area of the crash and observed the
vehicle at rest . They rushed down the
embankment and pushed the driver into the
seatback as he was bleeding profusely
from the nose. Another motorist, who
stopped at the scene, drove to a local
store and telephoned for police and
rescue assistance .
Police
Activities
Rescue
Activities
Several police units from the County
Sheriff's Department and the Highway
Patrol responded to the call and arrived
on-scene. The investigating officer
received notification of the crash and
arrived 4 7 minutes following the crash.
The local fire department and emergency
medical personnel responded to the scene.
They initially treated and evaluated the
driver in the vehicle. He had regained
consciousness, but was unaware of what
had occurred. The fllMfet requested the
service of a hel icdpt er transport to a
trauma center in tfl Htt CA.
18
The driver was removed from the vehicle
and carried up the embankment to an
awaiting ambulance. He was transported
to a remote helicopter landing site and
flown to the trauma center where he was
admitted for treatment of his injuries.
Scene
Clearance
Following the removal and subsequent
transport of the driver and the on- scene
police investigation, the vehicle was
winched up an embankment and towed from
the scene .
HUMAN FACTORS /OCCUPANT DATA
Driver:
Height :
Weight :
Occupation:
Active Restraint
System Usage :
Usage Source :
Eyeglasses :
Vehicle Familiarity:
Route Familiarity:
Trip Plan:
Manner of Transport
From Scene :
54 year old male
179.1cm (70.5")
99kg (220 lbs.)
Police officer
3 -point lap and shoulder belt system
Vehicle inspection, police report
None
Not assigned patrol vehicle, has
driven similar vehicles daily over
the past year
Daily, routine patrol area
In pursuit of a speeding vehicle
Ambulanced from the scene to an
emergency heliport then flown by
helicopter to a trauma center in
t, CA
Type of
Treatment :
Medical
Admitted to the hospital for 24 days
for treatment of his injuries,
readmitted for follow-up surgeries
19
DRIVER INJURIES
Injury
Fractured right
ribs 2-9 with flail
chest and right
hemothorax
Right pulmonary
contusion
Full thickness
thermal burns of
the dorsal aspect
of the left middle,
ring, and 5th
fingers with loss
of the extensor
tendons and
devascularization
of part of the
bones within the
digits
Comminuted fracture
of the right radial
head
Fracture of the
right proximal ulna
Closed head injury
with loss of
consciousness and
residual cognitive
deficits (amnesia) ,
negative head CT
Non-displaced
fracture of the
right zygoma
T 12 spinous process
fracture
Severity (OIC/AIS)
Severe (CRFS-4)
Serious (CRCP-3)
Minor (WLBI-1)
Serious (RRFS-3)
Moderate (RRFS-2)
Moderate (HWKB-2)
Moderate (FRFS-2)
Moderate (BSFS-2)
Source
Intruding right B-
pillar
Intruding right B-
pillar
Contact against the
air bag inflator
module
Intruding right
roof side rail
Intruding right
roof side rail
Intruding
panel
roof
Intruding
panel
roof
Right
fracture
clavicle
Moderate (SRFS-2)
Probable rebound
contact into left
front door panel or
seatback
Intruding right
roof side rail
20
Injury
nasal
Nasal laceration
Displaced
fracture
Right earlobe
laceration
Superior scalp
laceration
Dislocated
(loosened) teeth
nos . 5-8
Severity (OIC/AIS)
Moderate (FCFS-2)
Minor (FCLI-1)
Minor (HRLE-1)
Minor (HSLI-1)
Minor (FIDS-1)
Source
Intruding roof
Intruding roof and
headliner
Intruding roof and
headliner
Intruding roof and
headliner
Intruding
panel
roof
DRIVER KINEMATICS
The driver of the Ford Crown Victoria was in a normal seated
position pre-crash with both hands on the steering wheel while in
pursuit of the speeding vehicle. He was properly wearing the
manual 3 -point lap and shoulder belt system. Rstraint usage was
supported by driver interview data, blood stains on the upper
shoulder belt webbing, and from load induced abrasions on the inner
plastic surface of the latchplate. The driver stated that he
routinely drove the Crown Victoria with the seat adjusted to a mid-
track position and the seatback set to the most vertical position.
He added that the tilt steering wheel was adjusted to the center
position.
At impact with the trees, the supplemental driver's air bag
system deployed. The driver was probably slightly out of position
to his right due to the pre-crash counterclockwise rotation of the
vehicle. He was further displaced to his right by each tree impact
as he responded to the lateral impact forces. The driver's upper
torso slid out of the manual shoulder belt webbing while his pelvic
area loaded the lap belt portion of the 3 -point system. His
loading force against the lap belt pulled the webbing through the
latchplate which abraded the inner plastic surface of the
latchplate' s fixed crossbar. The driver's knees contacted the fuse
box cover and the knee bolster which scuffed the contacted
components. His right knee contacted the bolster at the protrusion
for the steering column and disrupted the vinyl covering of the
bolster. These contacts did not result in injury to the driver's
lower extremities. The lateral aspect of the driver's right knee
impacted the left edge of the lower mid instrument panel (scuff
mark) and the center mounted police radio equipment. The radio
equipment was removed from the vehicle prior to our inspection;
however, a bracket for the equipment was deformed to the right,
21
indicating driver contact. Again, no injury resulted from the
lower extremity contact .
The driver's right forearm flailed upward with respect to his
seated position and impacted the intruding right roof siderail
20. 3-29. 2cm (8-11.5") rearward of the upper A-pillar. Tissue
transfers evidenced the contact which resulted in a comminuted
fracture of the right radial head and a fracture of the right
proximal ulna. The driver's right shoulder subsequently impacted
and scuffed the intruding right roof side rail immediately forward
of the B-pillar. The contact fractured the mid-portion of the
driver's right clavicle. His right lateral chest area impacted the
intruding right upper B-pillar and possibly the struck tree as the
vehicle crushed to maximum engagement . Although no contact
evidence was visible on the vinyl jacket covering the B-pillar, the
driver sustained fractured right ribs 2-9 with flail chest, right
pneumothorax, and a right pulmonary contusion.
The driver's head impacted the intruding headliner and roof
panel on the right side of the vehicle. Due to the non-horizontal
impact with the tree, the roof was displaced to a vertical
orientation over the right front seated position. The head contact
was located 36. 8-50. 8cm (14.5-20") rearward of the upper right A-
pillar and 27.9cm (11") above the side rail. The driver's head
cracked the backer to the headliner and bowed the roof panel
approximately 0.6cm (.25") outward. Faint tissue transfers were
visible on the headliner material that surrounded the 11.4cm (4.5")
diameter contact. As a result of the impact, the driver sustained
a laceration of the superior scalp, a right earlobe laceration, a
nasal laceration with a displaced fracture of the nasal bone, a
fracture of the right zygoma, and a closed head injury with loss of
consciousness and residual cognitive deficits (amnesia) . In
addition to the head and facial injuries that were identified on
the medical reports, the driver stated that he sustained minor
dislocations (loosened) of the right upper teeth, nos . 5-8. The
dislocated teeth were attributed to the head and facial contact
with the intruding roof .
The driver subsequently rebounded across the interior of the
vehicle into the left front seatback and/or left front door panel.
He sustained a fracture of the spinous process of T 12 from the
probable rebound contact . There was no contact evidence to the
components from his rebound trajectory. Prior to coming to rest
within the vehicle, the driver's left hand moved under the upper
air bag module cover flap as the driver slumped forward in an
unconscious state against the steering wheel and the air bag module
assembly. The dorsal aspect of his left middle, ring, and fifth
fingers were pressed against the deflated air bag and the hot
inflation module. The heat from the stainless steel inflation
module melted the face of the bag and an internal tether strap at
the 10 o'clock position and was transmitted into the driver's
22
fingers, which resulted in full thickness thermal burns with loss
of the extensor tendons and devascularization of part of the bones
within the digits.
Several passing motorists noted the dust from the crash and
observed the vehicle at final rest. They rushed to the vehicle and
found the driver slumped against the steering wheel, bleeding
profusely from the nasal injuries onto the deflated air bag. The
motorists pulled the driver back into the seatback which disengaged
his hand from the air bag module assembly.
23
SELECTED PRINTS
Pre -crash Trajectory Of The Ford Crown Victoria.
24
Vehicle's Rotational Trajectory Across The Travel Lanes,
Beginning Of The Right Side Centrifugal Tire Marks.
25
Beginning Of The Left Side Centrifugal Tire Marks
26
Vehicle Departs Left Roadedge In A Near Broadside Orientation,
Vehicle Travels Down Earth Embankment
27
Struck Tree Branches
And 20.3cm (8") and 25.4cm (10") Diameter Cedar Trees
;
M
Remainder of Struck Trees .
28
Final Impact Sequence Against The 25.4cm (10") Diameter Tree,
Struck And Displaced Delineator Post
29
Mid Section Of The Struck
And Fractured 25.4cm (10") Diameter Tree.
Lookback View Of The Crash Scene ,
30
Lookback View Up The Earth Embankment .
Lookback View Of The Vehicle's Roadway Departure,
31
Frontal View Of The Ford Crown Victoria.
Tree Impact Damage To The Right Bumper Push Bar,
32
Left Front Three-Quarter View.
Left Side View.
33
Left Rear Three-Quarter View.
Rear View,
34
Right Rear Three -Quarter View.
Right Side View,
35
Primary Impact Damage To The Right Passenger Compartment Area,
Overhead View Showing The Extent Of Crush.
36
Tree Impact Damage To The Right Front Fender Area,
Right Front Three-Quarter View,
37
Overall View Of The Deployed Air Bag,
Melted Area Of The Deployed Air Bag,
38
BEST AVAILABLE
Additional Views Of The Melted Area Of The Air Bag.
39
Upper Air Bag Module Flap,
Perpendicular View Of The Module Flaps ,
40
BEST AVAILABLE
Interior View With The Air Bag Module Assembly Removed.
Driver's Trajectory And Contact Points.
41
BEST AVAILABLE
Knee And Lower Leg Contact Points
To The Knee Bolster And The Lower Panel
42
BEST AVAILABLE
Driver's Active 3-Point Belt System.
Belt Loading Abrasions To The Plastic Coating On The Latchplate.
43
BESTAVAILABLE
Probable Right Leg Contact To The
Center Mounted Radio Equipment (Removed)
Head, Arm, And Shoulder Contact Points
To The Intruding Roof And Side Rail .
44
BESTAVAILABLE
Head Contact To Headliner And Roof.
Right Shoulder And Arm Contacts To The Roof Side Rail .
45
BESTAVAILABLE
Apparent Tissue Transfer From Right Forearm Contact
To Roof Side Rail.
Location Of Burn With Respect To The Center Of The Air Bag,
46
BESTAVAILABLE
Closeup Views Of The Burned Area.
47
BESTAVAILABLE
Location Of Burn With Respect To The Peripheral Seam.
View Of A Melted Internal Tether Strap
Through The Left Venting Port,
48
w^mmm
Backside Of The Removed Module Assembly,
49
Removed Inflator Assembly From The Retaining Plate.
Melted Bag Material On The Face Of The Inflator,
50
Views Of The Radial Inflation Ports
Of The Inflator Assembly.
51
Additional Views Of The Radial Inflation Ports
52
Internal Views Of The Melted Areas Of The Air Bag,
53
"GRAPHIC"
PHOTOGRAPHS AND IMAGES
The following "GRAPHIC" Photographs and Images have been removed from this case.
If you would like a copy of these photographs and/or images please write to:
MARJORIE SACCOCCIO
VOLPE NATIONAL TRANSPORTATION SYSTEMS CENTER
55 BROADWAY
CAMBRIDGE, MA 02142
In the body of your request please include the case, photograph and image number(s).
Sectional View Of A Similar TRW Inflator.
55
SLIDE INDEX
Slide No (s) . Description
1 Accident schematic \
) KtM0)/E$ FOR SAjJiT\lAT\Q4/
2 Driver injury mannequin
3,4 Pre-crash trajectory of the police vehicle
5 Right rear tire begins to mark
6 Right front and left rear tires begin to mark
7 Left front tire begins to mark
8 Vehicle departs left roadedge in a near
broadside orientation
9 Vehicle traverses embankment and contacts tree
branches
10 Struck trees
11 Struck tree that resulted in severe right side
damage to vehicle
12 Final rest position of vehicle
13 Section of struck tree, impacted tree in
foreground
14 Lookback view of vehicle's trajectory
15 Frontal view of the Ford Crown Victoria
16 Left front three-quarter view
17 Left side view, LF door removed by rescue
personnel
18 Left rear three-quarter view
19 Rear view
20 Right rear three-quarter view
21 Right side view
22 Primary impact damage to right side area
23 Longitudinal view showing the extent of crush
56
SI:
ide No (s) .
24
25
26
27
28
SLIDE INDEX (CONT'D.)
Description
Right front three-quarter view
Overall interior view of the driver's
trajectory and contact points
Deployed driver's air bag
Steering wheel assembly with module removed
Burned (melted) area of air bag with tissue
from driver's hand contact
2 9 Location of burn mark with respect to
peripheral seam and vent port
3 Perpendicular view of the module flaps
31,32 Driver's knee/lower leg contacts to the knee
bolster
33,34 Driver's head, right shoulder and forearm
contacts to the intruding side rail and
headliner
35 Tissue transfer from right forearm contact
3 6 Right shoulder fabric transfer/impression on
headliner
37 Driver's head contact to headliner
3 8 Slight deformation to upper steering wheel rim
3 9 Blood stain on shoulder belt webbing
40 Belt abrasions to the latchplate
57
CASE NUMBER CA VM*
MISSING
SLIDES
THE FOLLOWING SLIDES ARE NOT INCLUDED IN THIS CASE:
SLIDE NUMBER(S)
-M2*
CA9212 #6
<4g
■A
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<p
CA9212 #12
ft*-
CA9212 #18
M
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CA9212 #24
M
CA9212 #26
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x ^\
*k ^
CA9212 #29
Best Available
n *
"" : '" ,;; "
APPENDIX A
Police Accident Report
58
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STATION LINES
A station line was established by laying a 100 ft. tapa
parallel to tha oenter of 8R-f*. station o+oo was
established at a point approximately 380 feet East of Kile
Foat A AHA 44.00
STATION LOO
i
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LOCATION:
DESCRIPTION:
0+00
R-8PT.3IN.
START OP SKID #1
O TRIM
LINE CENTRIFUGAL
SKID) '
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R-8FT.8IN.
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0+20
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0+30
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• R-9FT 10 IN.
SKID CONTINUES
0+50
R-10PT.0IH.
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R'lOPT: 31N
, SKID CONTINUES
0+70
R-10PT. 4 in
SKID CONTINUES
0+80
R-10FT. 8 IN
SKID CONTINUES
0+90
R-10FT. 7 IN
SKID CONTINUES
1+10
R-10FT. 6IH
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1+20
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SKID CONTINUES
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R-10FT. 4IN
SKID CONTINUES
.
1+40
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. " SKID CONTINUES
•
.
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•
1+60
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[. SKID CONTINUES
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R-8PT. 2 IV
1. SKID CONTINUES
2+00
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2+10
R-6FT. 7 IN.
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. 2+30
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2+50
.R-2PT. 2IN,
SKID CONTINUES
.
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L-l FT OIN.
LOCATION I
L-4FT 8IN.
L-9FT. 0IN.
L 13 FT.
L 18FT 2 IN.
SKID CONTINUE!
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DESCRIPTION:
SKID 11 CONTINUES
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SKID LEAVES ASPHALT
8KID GOES OVER EMBANK-
MENT.
0+60
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R-11FT.10IN.
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R-12FT. 8IN.
R-12FT. 51N.
R-11FT. 10IN.
R-10FT. 9IN.
R-9FT. 4 IN.
R-7FT. 1 IN.
R-4FT. 6 IN.
R-1FT. OIN.
L-1FT. UN.
L-5FT. 8IN.
L-10FT.5IN.
L-16FT. 4IN.
START OF SKID #2
SKID CONTINUES
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ASPHALT, WHICH IS
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SKID CONTINUES.
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SKID CONTINUES
SKID CONTINUES
SKID CONTINUES
SKID CONTINUES
SKID CONTINUES
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SKID AND AT THE RT.
EDGE LINE).
SKID CONTINUES
SKID CONTINUES
SKID CONTINUES
SKID CONTINUES
SKID CONTINUES
SKID CONTINUES, A THICK
SIDE SKID.
SKID ON EDGE LINE
SKID ENDS OVER THE
EMBANKMENT.
2+10
2+30
2+40
2+60
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CENTER LINE
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START OF SKID #3.
SKID CONTINUES ACROSS
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SKID CONTINUES
8KID CONTINUES
u« •diiona until depleted.
63
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8KID CONTINUES .
SKID CONTINUES ..
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8KID CONTINUES
SKID CONTINUES
SKID CONTINUE8
SKID CONTINUES
SKID CONTINUES
SKID CONTINUES
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END OF SKID THAT HAS
VISIBLE.
LOWER LIMBS OF FINE
TREE DAMAGED TO A HEIGHT
OF 8FT 2 INCHES ABOVE
GROUND LEVEL.
MARKS IN THE DIRT ft
BRUSH LEFT BT V-l. .
STUMP OF FINE TREE,
DOWNED TREE S. OF
STUMP .
STUMP OF PINE TRSfe*
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SAME AREA.
POINT OF REST OF V-l AT
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POSITION.
HSVCWCKSNAUE
OATi
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/
APPENDIX B
Air Bag Supplement
76
Dup. Cols. 1-8
from prior card
Modu le A £
Format Q. 1
AIRBAG SUPPLEMENT AB-1
ACCIDENT SUMMARY
ACCIDENT DATE
/ ^
POLICE INVESTIGATED (1,2,9)*
City
County:!
GENERAL LOCALITY
(1) Freeway, Limited Access
(2) Urban (City)
(3) Urban-Rural (mixed)
(4) Rural, Fields
CONFIGURATION (First Harm)
(0) Struck Object or Pedestrian
(1) Rear-End OxKvrt*^.
(2) Head-On
(3) Rear-to-Rear
(4) Angle
(5) S Idesw Ipe-Same Direction
(6) Sideswipe-Opposite Direct.
(7) NonCollteg Fell frOm Veh
(8) Nonimpact Deployment
(9) Unknown
FIRE INVOLVED (0) None
(1 ) AlrBag Vehicle
(2) Other Vehicle
(3) Both Vehicles
(9) Unknown
NUMBER: VEHICLES INVOLVED
(8)=8 or more
PERSONS INVOLVED
INJURED PERSONS
MAXIMUM AIS IN ACCIDENT
OTHER VEHICLE: MAXIMUM AIS
PRIME/DEPLOY IMPACT w AB VEH:
EVENT NUMBER /
CDC - 'Zi-
TOTAL DELTA-V
Model Year, Make, Model, Body Ty
ii.
_Ql
O
pe:
AIRBAG VEHICLE INSPECTION
DATE VEH. INSPECTED
REASON VEHICLE NOT INSPECTED
(0) Not Required
(1) Inspection Completed
(2) Cannot be Located**
(3) Repaired or Destroyed**
(5) Refual or Impounded**
(7) Other*
••Specify:
/±^
IMPACT DATA OBTAINED
(0) No Data Obtained
(1) CDC Only
(2) Crush Prof I le Only
(3) Trajectory Data Only
(4) CDC and Crush Profile
(5) CDC and Trajectory
(6) Crush and Trajectory
(7) CDC, Crush & Trajectory
BASIS OF DELTA-V
(0) Not Computed (Unknown Why)
(1) CRASH - Damage Only
(2) CRASH - Damage+Trajectory
(3) Missing Vehicle Algorithm
(4) Yielding Object Algorithm
(5) Unknown Basis
(6) One Vehicle Beyond Scope
(7) Collision Beyond Scope
(8? Insu fficient Data
-3-
VEHICLE HISTORY
HAS AIRBAG VEHICLE BEEN IN
ANY PRIOR IMPACTS (1,2,9)*
HAS ANY PRIOR MAINTENANCE/SERVICE
BEEN PERFORMED ON SYSTEM ( 1 , 2,9 ) *
*Descr I be:
o2-
"AIRBAG VEHICLE: FLEET f oucC
VlN^LA.Qe.2^ £>.£.KX_ _
MILEAGE Jbflrt
* (1)=Yes, (2)=No, (9)=Unknown
DRAFT -
77
BEST AVAILABLE COPY
READINESS LAMP, FIRST HARM
AIRBA6 SUPPLEMENT AB-2
SYSTEM READINESS LAMP
(In Instrument Cluster)
PRE- IMPACT LAMP CONDITION
(1) Funct Ion Ing/ProvedOut
(2) Inoperative
(9) Unknown
DRIVER'S REPORT OF
PRE-IMPACT FLASHING
No Flashing Reported
Continuous Flashing
of Flashes
(00)
(01 )
(02)
— >Number
(11 )
(12) Constant Light
(19) Flashing, Unkn Number
(88) Not App (system removed)
(99) Unknown
PERIOD OF PRE-IMPACT FLASHING
(0) No Flashing
(1) Same Day as Impact
(2) Prior Day
(3) Pr ior Two Days
(4) Prior Week
(5) Prior Month
(6) Over One Month
(9) Unknown
POST-IMPACT LAMP CONDITION
(1) Funct Ion I ng/ProvedOut
(2 ) I noperat I ve
(9) Unknown
POST-IMPACT FLASHING
_0 o.
No Flashing
Continuous F
(00)
(01) Continuous Flashing
(02)
-- >Number of Flashes
(11 )
(12) Constant Light
(19) Flashing, Unkn Number
(86) Not Appl (removed)
(99) Unknown i^oPee/srit^
_2^_
AIRBAG VEHICLE
FIRST HARMFUL EVENT
,i4_
(01) Firt or explosion
(02) Immersion
(03) Gas Inhalation
(04) Fell from vehicle
(05) Injured in vehicle
(06) Other •oocollision (specify):
(07) Overturn
(08) Jackknife with intraunit damage
Collision With: I
(09) Pedestrian J
(10) Pedalcyclist |
(11) Railway train j
(12) Animal
(13) Motor vehicle in transport (same
roadway)
(14) Motor vehicle in transport (other
roadway)
(15) Parked motor vehicle
(16) Other type nonmotorist (specify):
(17) Thrown or falling object
(18) Boulder
Collision with Fixed Object:
(20) Building
(21) Impact attenuator /Crash Cushion
(22) Bridge pier or abutment
(23) Bridge parapet end
(24) Bridge rail
(25) Guardrail
(26) Concrete traffic barrier
(27) Median barrier
(28) Other longitudinal barrier (specify):
(29) Highway/Traffic sign post i
(30) Overhead sign support
(33) Luminaire 'Light support
(32) Utility pole
(33) Other post, pole, or support (specif)): CDEUA*^^ ^
(34) Culvert
(35) Curb
(36) Ditch
(3^) Embankment-earth
(38) Embankment -rock, stone or concrete
(39) Fence (wooden, wire, chain link, etc )
(40 ) Wall (stone, rock, meta], etc.)
(41) Fire hydrant
(42) Shrubbery
(43) Tree
(44; Other fixed object (specify):
(45) Pavement surface irregularity (pothole,
grooved, grates)
(99 ) Unknown
78
BEST AVAILABLE COPY
URBAG VEHICLE IMPACT-DAMAGE
AIRBAG SUPPLEMENT AB-3
URBAG VEHICLE IMPACT SUMMARY
FIRST AIRBAG VEHICLE IMPACT:
VEHICLE ROLE
J_
CONFIGURATION
0) Non-col 1 Is Ion
(0) Struck Object or Pedestrian
il) Striking Unit
(1 ) Rear-End
(2) Struck Unit
(2) Head-On
(3) Rear-to-Rear
13) Both Striking and Struck
19) Unknown
(4) Angle
JL
(5) Sideswipe - Same Direction
MANNER OF LEAVING SCENE
(6) Sideswipe-Opposite Direct.
(7) NonColl:eg Fell from Veh
( 1 ) Dr I ven
(6) Nonimpact Deployment
(2) Towed-due to damage
(9) Unknown
[3) Towed - not for damage
(4) Towed - details unknown
CDC _DA--JLJL-£J0--L
(5) Abandoned
,
[9) Unknown
OBJECT CONTACTED: DeuMXTOtL
NUMBER OF IMPACT EVENTS
Ji_
(8) 8 or more, (9) Unknown
PRIMARY/DEPLOYMENT. IMPACT:
ROLLOVER (0) No Rollover
Q
A
(1 ) First Event
EVENT NUMBER
(2) Subsequent Event
(3) Yes,UnknownEvent
TOTAL DELTA-V
(9) Unknown
J_
LONGITUDINAL DELTA-V
)VERRIDE/UNDERRIDE
CONFIGURATION
{ 1 ) No over/underrlde
(1 ) Override - 1st CDC
(0) Struck Object or Pedestrian
(3) - Other CDC
( 1 ) Rear-End
(4) Underrlde - 1st CDC
(2) Head-On
(3) Reai — to-Rear
[6) - Other CDC
(9) Unknown
(4) Angle
(5) Sideswipe - Same Direction
MRBAG VEHICLE DAMAGE
(6) Sideswipe-Opposite Direct.
(7) NonColl:eg Fell from Veh
CODES: (1 ) Yes, DAMAGED
(8) Nonimpact Deployment
(2) No Damage
(9) Unkonwn
(9) Unknown
CDC - -
LEFT FRONT FENDER DAMAGE
i
OBJECT CONTACTED: -p^fff
^IGHT FRONT FENDER DAMAGE
I
1
CENTER TOP OF GRILLE DAMAGE
NOTES:
fcASH ;
r R0NT BUMPER E.A. STATUS: Left
JL
SP£c\f'ic eoe^T °°^^ ua>ka>ooimj
(1) Normal Right
_3_
(2) Extended
(3) Partial Compression
(4) Complete Compression
(5) Not Appl Icable
19) Unknown
79
BEST AVAILABLE COPY
SYSTEM DAMAGE
AIRBAG SUPPLEMENT AB-4
MRBAG SYSTEM DAMAGE
CODES: (1) Yes, Damaged*
(2) No, Intact
(8) Not App. (Removed)
(9) Unknown
AIRBAG MODULE
SENSORS: Left Front
Center Front
Right Front
Rear, Cowl
DIAGNOSTIC MODULE
WIRING
KNEE DIVERTER
INDICATION OF DISCONNECTED
OR LOOSE ELECTRICAL
CONNECTORS
a.
x
a.
CONDITION OF DEPLOYED BAG
(1) Bag Intact
(2) Spl It or Torn*
(3) Cut by Object In Impact*
(4) Cut after Accident*
(5) Other (e.g., burned)*
(8) N/A (not deployed)
(9) Unknown
S-
•DESCRIBE System and Bag Damage:
NOTE DAMAGE AND CONTACT MARKS ON AIRBAG DIAGRAMS BELOW
&->£a> o*j f/vc<r of G«6
TOP
BOTTOM
FRONT
80
BACK
BEST fiv'fllLABLE COPY
BEST AVAILABLE COPY
OCCUPANTS/DRIVER
AIRBAG SUPPLEMENT AB-5
OCCUPANTS of AIRBAG CAR
DUMBER OF OCCUPANTS IN VEHICLE
(8) 8 or more
NUMBER OF INJURED PERSONS
MAXIMUM AIS IN AIRBAG VEHICLE
(0) No Injury
(1-6) AIS Severity
(7) Injured, Unknown Severity
(9) Unknown
DRIVER AGE SH SEX MftLC
NUMBER OF DRIVER INJURIES
SOURCE OF BEST INJURY DATA
(0) Not Injured
(1) Autopsy */*o med. records
(2) Hospital Medical Records
(3) Emergency Room only
(4) Private phys Ic I an ,C I In Ic
(5) Ley Coroner Report
(6) EMS Personnel
(7 ) I nterv lewee
(8) Pol Ice
(9) Unknown
NOTES:
MAXIMUM AIS BY BODY REGION
REGION MAX AIS
Head/Neck/Face 3>
Dhest H
Abdomen
Leg/Hips
Other (Arms) 3>
DRIVER MAXIMUM H
CONTACT
±15
3 3>
EJECTION: Extent AJftOgT
Portal a /a
81
, j
DRIVER-PASSENGER AIRBAG SUPPLEMENT AB-6
DRIVER BELT USAGE; (1) Used (2) Not Used (9) Unknown _J
Evidence; Pot-icg teflagr iLorroESA. CT/rrg/feXT^ f /^AfA-Siao^ Q*J atXSing
DRIVER POSTURE; Any Comments Recorded (1) Yes, (2) No _J_
Describe drlver*s posture and position on seat Including specific comments
on head, torso, buttocks, legs and feet. Also note hand and arm position.
Did driver brace before crash? Describe:
DRIVER FOREIGN OBJECTS; Comments Recorded (1) Yes, (2) No _JL
Was driver wearing contact lenses or eyeglasses? Or holding any foreign
object at the time of the Impact (packages on lap, pipe, food, bottle,
cigarette, etc.)? Did any lenses, objects, or jewelry play any role?:
DRIVER COMMENTS; Comments Recorded (1) Yes, (2) No 3.
Was the driver aware that the vehicle was equipped with a supplemental
restraint system? Did driver offer any comments on smoke, noise, etc.?
Did the driver comment on the alrbag as a restraint system? Describe:
PFm&&£& ^K£ i&X. QE 3%£ CW>ti
PASSENGER-AIRBAfi C ON TACT (1) Yes, (2) No, (9) Unknown iL_
Describe: A3 O faaeOfcgfc,
._J
Irbag. supp/Jcm 9/4/85
82
APPENDIX C
NASS Vehicle Forms
83
U.S. D#p«rtm#nt of Transportation
.National Highway Traffic Saf aty
t Admtnbtratton
GENERAL VEHICLE FORM
NATIONAL ACCIDENT SAMPLING SYSTEM
CRASHWORTHINESS DATA SYSTEN
1 . Prim a ry S a mpl i n g Un i t Numb e r
2. Case Number - S tr a tum 3- 3~~ L -A=
3. Vehicle Number O i
VEHICLE IDENTIFICATION
4. Vehicle Model Year
Code the last two digits of the model year
(99) Unknown
Vehicle Make (specify):
Eo*h
Applicable codes are found in your
NASS Data Collection, Coding and
Editing Manual.
(99) Unknown
i_L
i L
6.
Vehicle Model (specifylj
/■T/V CftS""^ UlCTQfttfit
o I G
1 1 . Police Reported Alcohol Presence O
(0) No alcohol present
(1) Yes (alcohol present)
(7) Not reported
(8) No driver present
(9) Unknown
Note: See variables 37 through 55
(Page 4) for information on Other Drugs
12. Alcohol Test Result For Driver °\ b
Code actual value (decimal implied
before first digit— O.xx)
(95) Test refused
(96) None given
(97) AC test performed, results unknown
(98) No driver present
(99) Unknown
Source:
Applicable codes are found in your
NASS Data Collection, Coding and
Editing Manual.
(999) Unknown
A*-(Cg uem ece*
7. Body Type OH
Note: Applicable codes may be found on
the back of this page.
8. Vehicle Identification Number
Left justify; Slash zeros and letter Z (0 and Z)
No VIN— Code all zeros
Unknown —Code all nine's
OFFICIAL RECORDS
9. Police Reported Vehicle Disposition
(0) Not towed due to vehicle damage
(1) Towed due to vehicle damage
(9) Unknown
10. Police Reported Travel Speed 7 H
Code to the nearest mph (NOTE: 00 means
less than 0.5 mph)
(97) 96.5 mph and above
(99) Unknown
ACCIDENT RELATED
1 3. Speed Limit S *>
(00) No statutory limit
Code posted or statutory speed limit
(99) Unknown
14. Attempted Avoidance Maneuver O 3
(00) No impact
(01 ) No avoidance actions
(02) Braking (no lockup)
(03) Braking (lockup)
(04) Braking (lockup unknown)
(05) Releasing brakes
(06) Steering left
(07) Steering right
(08) Braking and steering left
(09) Braking and steering right
(10) Accelerating
(11) Accelerating and steering left
(12) Accelerating and steering right
(97) No driver present
(98) Other action (specify):
(99) Unknown
15. Accident Type QJX-
Applicable codes may be found on the
back of page two of this field form
(00) No impact
Code the number of the diagram that
best describes the accident circumstance
(98) Other accident type (specify):
(99) Unknown
#### SKIP TO VARIABLE GV37 IF GV07 DOES NOT EQUAL 01-49 * ## *
HS Form 435 <Rav. 1/92)
84
CODES FOR BODY TYPE
CDS APPLICABLE VEHICLES
Automobiles
(01) Convertible (excludes sun-roof, t-bar)
(02) 2-door sedan, hardtop, coupe
(03) 3-door/2-door hatchback
(04) 4-door sedan, hardtop
(05) 5-door/4-door hatchback
(06) Station wagon (excluding van and truck based)
(07) Hatchback, number of doors unknown
(08) Other automobile type (specify):
(09) Unknown automobile type
Automobile Derivatives
(10) Auto based pickup (includes El Camino, Caballero,
Ranchero, Brat, and Rabbit pickup)
(11) Auto based panel (cargo station wagon, auto based
ambulance/hearse)
( 1 2) Large limousine - more than four side doors or stretched
chassis
(13) Three-wheel automobile or automobile derivative
Utility Vehicles (x 10,000 lbs GVWRI
(14) Compact utility (Jeep CJ-2 • CJ-7, Scrambler, Golden
: Eagle, Renegade, Laredo, Wrangler, Cherokee [84 and
after]. Dispatcher, Raider, Bronco II, Bronco [76 and
before]. Explorer, S-10 Blazer, Geo Tracker, Bravado,
S-16 Jimmy, Thing, Pathfinder, Trooper, Trooper II,
Rodeo, Amigo, Navajo, 4-Runner, Montero, Samurai,
Sidekick, Rocky)
(15) Large utility (includes Jeep Cherokee [83 and before],
Ramcharger, Trailduster, Bronco-fullsize [78 and after],
fullsize Blazer, fullsize Jimmy, Landcruiser, Rover,
Scout)
(16) Utility station wagon (Chevy Suburban, GMC Suburban,
Traveled, Grand Wagoneer, includes suburban
limousine)
(1 9) Utility, unknown body type
Van Based Light Trucks (* 10,000 lbs GVWRI
(20) Minivan (Chrysler Town and Country, Caravan, Grand
Caravan, Voyager, Grand Voyager, Mini-Ram,
Dodge/Plymouth Vista, Aerostar, Lumina APV, Trans
Sport, Silhouette, Astro, Safari, Toyota Van, Toyota
Minivan, Previa, Nissan Minivan, Mitsubishi Minivan,
Vanagon/Camper.)
Large van (B150-B360, Sportsman, Royal, Maxiwagon,
Ram, Tradesman, Voyager [83 and before], E150-E350,
Econoline, Clubwagon, Chateau, G10-G30, Chevy Van,
Beauville, Sport Van, G15-G35, Rally Van, Vandura.)
Step van or walk-in van (£ 10,000 lbs GVWR)
Van based motorhome (£ 10,000 lbs GVWR)
Other van type (Hi-Cube Van, Kary) (specify):
(29) Unknown van type ~ ~
Light Conventional Trucks (Pickup style cab,
<, 10,000 lbs GVWR)
(30) Compact pickup (D50, Colt P/U, Ram 50, Dakota,
Arrow Pickup [foreign], Ranger, Courier, S-10 , T-10,
LUV, S-15, T-15, Sonoma, Datsun/Nissan Pickup, P'up,
Mazda Pickup, Toyota Pickup, Mitsubishi Pickup)
(31) Large Pickup (Jeep Pickup, Comanche, Ram Pickup,
D100-D350, W100-W3B0, F100-F350, C10-C35, K10-
K36, R10-R35, V10-V35, Silverado, Sierra, R100-
R500,)
(32) Pickup with slide-in camper
(33) Convertible pickup
(39) Unknown pickup style light conventional truck type
(21)
(22)
(23)
(28)
Other Light Trucks {* 10,000 lbs GVWR)
(40) Cab chassis based (includes rescue vehicles, light
stake, dump, and tow truck)
(41) Truck based panel
(42) Light truck based motorhome (chassis mounted)
(45) Other light conventional truck type
(48) Unknown light truck type
(49) Unknown light vehicle type (automobile, utility, van, or
light truck)
OTHER VEHICLES
Buses (Excludes Van Based)
(50) School bus (designed to carry students, not
cross country or transit)
(58) Other bus type (e.g., transit, intercity, bus based
motorhome) (specify):
(59) Unknown bus type
Medium/Heavy Trucks (> 10,000 lbs GVWR)
(60) Step van (> 10,000 lbs GVWR)
(61) Single unit straight truck (10,000 lbs < GVWR £
19,600 lbs)
(62) Single unit straight truck (19,500 lbs < GVWR £
26,000 lbs)
(63) Single unit straight truck (> 26,000 lbs
GVWR)
(64) Single unit straight truck, GVWR unknown
(65) Medium/heavy truck based motorhome
(67) Truck-tractor with no cargo trailer
(68) Truck-tractor pulling one trailer
(69) Truck-tractor pulling two or more trailers
(70) Truck-tractor (unknown if pulling trailer)
(78) Unknown medium/heavy truck type
(79) Unknown truck type (light/medium/heavy)
Motored Cycles (Does Not Include Alt-Terrain
Vehicles/Cycles)
(80) Motorcycle
(81 ) Moped (motorized bicycle)
(82) Three-wheel motorcycle or moped
(88) Other motored cycle (minibike, motorscooter)
(specify) :
(89) Unknown motored cycle type
Other Vehicles
(90) ATV (All-Terrain Vehicle) and ATC (All-Terrain Cycle)
(91) Snowmobile
(92) Farm equipment other than trucks
(93) Construction equipment other than trucks
(97) Other vehicle type
(99) Unknown body type
85
National Accident Sampling System-Crashworthiness Data System: General Vehicle Form
Page 2
OCCUPANT RELATED
16.
Driver Presence in Vehicle
(0) Driver not present
(1) Driver present
(9) Unknown
1 7. Number of Occupants This Vehicle
(00-96) Code actual number of occupants"
for this vehicle
(97) 97 or more
(99) Unknown
n±
18. Number of Occupant Forms Submitted Q {
VEHICLE WEIGHT ITEMS
19. Vehicle Curb Weight
3jB*Q. Code weight to nearest
1 100 pounds.
(010) Less than 1050 pounds
(1 35) 1 3,500 pounds or more
(999) Unknown
Source:
O 3 , 8 00
20. Vehicle Cargo Weight
( O Code weight to nearest
O . 100
(00, uSSSw,™* PeWp^faH" 5 *
(97) 9,650 pounds or more
(99) Unknown
24. Rollover J
(0) No rollover (no overturning)
Rollover (primarily about the longitudinal axis)
(1) Rollover, 1 quarter turn only
(2) Rollover, 2 quarter turns
(3) Rollover, 3 quarter turns
(4) Rollover, 4 or more quarter turns (specify):
(5) Kollover-end-over-end (i.e., primarily
about the lateral axis)
(9) Rollover (overturn), details unknown
25. Front Override/Underride (this Vehicle) Q
26. Rear Override/Underride (this Vehicle) Q
(0) No override/underride, or
not an end-to-end impact
Override fsee specific CDC)
(1) 1st CDC
(2) 2nd CDC
(3) Other not automated CDC (specify):
RECONSTRUCTION DATA
21. Towed Trailing Unit
(0) No towed unit
(1) Yes— towed trailing unit
(9) Unknown
22. Documentation of Trajectory Data
for This Vehicle
(0) No
(1) Yes
23. Post Collision Condition of Tree or Pole
(For Highest Delta V)
(0) Not collision (for highest delta V) with
tree or pole
(1) Not damaj ^
(2) Crackedtfsheared
(3) Tilted <45TJBgfees
(4) Tilted ^45 degrees
(5) Uprooted tree
(6) Separated pole from base
(7) Pole replaced
(8) Other (specify):
(9) Unknown
O
Underride (see specific CDC)
(4) 1st CDC
(5) 2nd CDC
(6) Other not automated CDC (specify):
(7) Medium/heavy truck or bus override
(9) Unknown
HEADING ANGLE AT IMPACT FOR
HIGHEST DELTA V
Values: (000M359) Code actual value
(997) Noncollision
(998) Impact with object
(999) Unknown
27. Heading Angle For This Vehicle J
28. Heading Angle For Other Vehicle *\ *\ %
S
86
BEST AVAILABLE COPY
Cate-
gory
Configur-
ation
ACCIDENT TYPES (includes Intent)
A.
Right
Roadside
Departure
DRIVE OFF
ROAD
CONTROL/
TRACTION LOSS
03 r "_~i
AVOID COLLISION
WITH VEH.. PED.. ANIM.
04
SPECIFICS
OTHER
06
SPECIFICS
UNKNOWN
Mi
B
Left
Roadside
Departure
DRIVE OFF
ROAD *
CONTROL/
TRACTION LOSS
AVOID COLLISION
WITH VEH.. PED.. ANIM.
09
SPECIFICS
OTHER
10
SPECIFICS
UNKNOWN
C
Forward
Impact
11
12
13
14
PARKED VEH. STA. OBJECT PEDESTRIAN/
ANIMAL
1 —
END
DEPARTURE
15
SPECIFICS
OTHER
16
SPECIFICS
UNKNOWN
to t-
c E
n r*
£ 5
D
Rear-End
20 -^22
— ^23
STOPPED SLOWER
21. 22. 23 », 26. 27
28
DECEL.
2S.30. H
30
► 2
31
-C^ 29
(EACH • 32) (EACH • 33)
SPECIFICS
OTHER
SPECIFICS
UNKNOWN
E
Foruard
Impact
O 36 /y»» c:>
36 » -37
\ZV> (EACH • 42) (EACH • 43)
41
CONTROL/
TRACTION LOSS
CONTROL/
TRACTION LOSS
AVOID COLLISION
WITH VEH.
AVOID COLLISION SPECIFICS
WITH OBJECT OTHER
SPECIFICS
UNKNOWN
F
Sideswipe
Angle
44
46
46-
45-
47.
(EACH • 48)
SPECIFICS
OTHER
(EACH • 49)
SPECIFICS UNKNOWN
G
Head-On
60 ♦^L- (EACH •52)
* 0000 '^ SPECIFICS
LATERAL MOVE OTHER
(EACH • 63)
SPECIFICS UNKNOWN
H
Forward
impact
CONTROL/
TRACTION LOSS
CONTROL/
TRACTION LOSS
CJ (EACH • 62KEACH • 63)
61
AVOID COLLISION AVOID COLLISION SPECIFICS SPECIFICS
WITH VEH. WITH OBJECT OTHER UNKNOWN
I
Sideswipe 7
Angle
(EACH • 66)
SPECIFICS
OTHER
(EACH • 67)
SPECIFICS UNKNOWN
* Ob
o c
i!
I- H
%j o
£3
CO JZ
JZ C
u >
J.
Turn
Across
Path
x/~
68
INITIAL OPPOSITE
DIRECTIONS
INITIAL SAME DIRECTIONS
<EACH»74)(EACH«75)
SPECIFICS SPECIFICS
OTHER UNKNOWN
K
Turn Into
Path
79 _ » ^ +
TURN INTO SAME DIRECTION
TURN INTO OPPOSITE DIRECTIONS
(EACH • 84) (EACH • 85)
SPECIFICS SPECIFICS
OTHER UNKNOWN
jz v i>
2? 3 8P
5 .E iO
L
Straight
Paths
r -i-
(EACH • 90)
SPECIFICS
OTHER
(EACH • 91)
SPECIFICS UNKNOWN
8 8
M
Backing
Etc. *
92
BACKINO
VEH.
93
OTHER VEH.
OR OBJECT
98 Other Accident Type
99 Unknown Accident Type
00 No Impact
87
National Accident Sampling System-Crashworthiness Data System: General Vehicle Form
Page 3
£.
29. Basis for Total Delta V (highest)
Delta V Calculated
(1) CRASH program— damage only routine
(2) CRASH program— damage and trajectory
routine
(3) Missing vehicle algorithm
Delta V Not Calculated
(4) At least one vehicle (which may be this
vehicle) is beyond the scope of an acceptable
reconstruction program, regardless of
collision conditions.
(5) All vehicles within scope (CDC applicable)
of CRASH program but one of the collision
conditions is beyond the scope of the CRASH
program or other acceptable reconstruction
technique, regardless of adequacy of damage
data.
(6) All vehicle and collision conditions are within
scope of one of the acceptable reconstruction
programs, but there is insufficient data
available.
COMPUTER GENERATED DELTA V
Secondary Highest
+
32. Lateral Component of Delta V
Nearest mph
3_a.
34,
30. Total Delta V
Secondary Highest
^3_
Nearest mph
31.
(NOTE: 00 means less than
0.5 mph)
(97) 96.5 mph and above
(99) Unknown
Longitudinal Component of
Delta V
^A_a.
Nearest mph
(NOTE: 00 means greater than
-0.5 and less than +0.5 mph)
(±97) ±96.5 mph and above
( 99) Unknown
36.
(NOTE: 00 means greater than
-0.5 and less than +0.5 mph)
(±97) ±96.5 mph and above
(_99) Unknown
33. Energy Absorption \ _\ \ , a
Nearest 1 00 foot-lbs
(NOTE: 0000 means Irss than 50 foot-lbs)
(9997) 999,650 for . tbs or more
(9999) Unknown
Confidence In Reconstruction Program
Results (For Highest Delta V) Q
(0) No reconstruction
(1) Collision fits model — results appear
reasonable
(2) Collision fits model — results appear high
(3) Collision fits model — results appear low
(4) Borderline reconstruction — results appear
reasonable
35. Type of Vehicle Inspection
(0) No inspection
(1) Complete inspection
(2) Partial inspection (specify):
Is this an AOPS Vehicle?
(0) No
(1) Yes
IS OLDMISS APPLICABLE FOR THIS VEHICLE? [ ] YES [ ] NO
IF YES: IS A COMPLETED OLDMISS PROGRAM SUMMARY INCLUDED? [ ] YES [ ] NO
88
National Accident Sampling System-Crashworthiness Data System: General Vehicle Form
Page 4
37. Police Reported Other Drug Presence
(0) No other drugs present
(1) Yes (other drug present)
(7) Not reported
(8) No driver present
(9) Unknown
38. Police Reported Observation/Perception
Test Type For Driver
(0) No observation/perception test given
(1) Drug recognition technician (DRT)
determination using DEC process
(2) Behavioral
(3) Other physical observation/perception
determination (specify):
(4) DEC process available, unknown if
determination made
(5) DEC process not available, unknown if
other observation/perception test given
(7) Other observation/perception test
(specify) :
(8) No driver present
39. Other Drug Specimen Test Type For Driver
(0) No specimen test given
(1) Blood test
(2) Urine test
(3) Other specimen tests (specify):
(7) Unspecified specimen test
(8) No driver present
(9) Unknown if specimen test given
JL
DRUG EVALUATION CLASSIFICATION
OTHER DRUGS TEST RESULTS FOR DRIVER
_Q
DEC
Observation/
Specimen
Perception
Test
Test Results
Results
40. O
41. O
42. O
43. a
44. O
45. O
46. O
47. D
48. o
49. o
50. o
51. a
52. o
53. q
54. n
55. O
Narcotic Drug
Depressant Drug
Stimulant Drug
Hallucinogen Drug
Cannabinoid Drug
Phencyclidine (PCP)
Inhalant Drug
Other Drug (Excluding
Nicotine, Aspirin, Alcohol,
Drugs Administered Post-Crash)
Codes For Observation/Perception Test Results
(0) No DEC observation/perception test given
(1) Passed DEC observation/perception test
(2) Failed DEC observation/perception test
(3) DEC observation/perception test given—
results unknown
(8) No driver present
(9) Unknown if DEC observation/perception
test given
Codes for Specimen Test Results
(0) No specimen test given
(1) Drug not found in specimen
(2) Drug found in specimen
(7) Specimen test given, results unknown or
not obtained
(8) No driver present
(9) Unknown if specimen test given
89
National Accident Sampling System-Crashworthiness Data System: General Vehicle Form
Page 5
OTHER DATA
61 . Rollover Initiation Object Contacted O O
62. Location on Vehicle Where Initial Principal O
Tripping Force Is Applied
(0) No rollover
(1) Wheels/tires
(2) Side plane
(3) End plane
(4) Undercarriage
(5) Other location on vehicle (specify):
56. Driver's Zip Code m W
(00000) Driver not present
(00001) Driver not a resident of U.S. or territories
Code actual 5-digit zip code
(99999) Unknown
57. Driver's Race/Ethnic Origin I
(0) Driver not present
(1) White (non-Hispanic)
(2) Black (non-Hispanic)
(3) White (Hispanic)
(4) Black (Hispanic)
(5) American Indian, Eskimo or Aleut
(6) Asian or Pacific Islander
(8) Other (specify):
(8) Non-contact rollover forces (specify):
(9) Unknown
63. Direction of Initial Roll O
(0) No rollover
(1) Roll right - primarily about the longitudinal axis
(2) Roll left - primarily about the longitudinal axis
(5) End-over-end (i.e., primarily about the lateral
axis)
(9) Unknown roll direction
(9) Unknown
58. Vehicle Special Use (This Trip) iT
10) No special use
(1) Taxi
(2) Vehicle used as school bus
(3) Vehicle used as other bus
(4) Military
(5) Police
(6) Ambulance
(7) Hearse
(8) Fire truck or car
(9) Unknown
PRECRASH DATA
64. Pre-Event Movement (Prior to ( o
Recognition of Critical Event)
(01) Going straight
(02) Slowing or stopping in traffic lane
(03) Starting in traffic lane
(04) Stopped in traffic lane
(05) Passing or overtaking another vehicle
(06) Disabled or parked in travel lane
(07) Leaving a parking position
(08) Entering a parking position
(09) Turning right
(10) Turning left
(11) Making a U-turn
(12) Backing up (other than for parking position)
(13) Negotiating a curve
(14) Changing lanes
(15) Merging
(16) Successful avoidance maneuver to a previous
critical event
(97) Other (specify):
ROLLOVER DATA
If GV07 (Body Type) * 1-49, leave GV59-GV63 blank.
If GV24 (Rollover) = 0, then GV59-GV63 must equal 0.
If GV24 = 9, then GV59-GV63 must equal 9.
59. Rollover Initiation Type Q
(0) No rollover
(1) Trip-over
(2) Flip-over
(3) Turn-over
(4) Climb-over
(5) Fall-over
(6) Bounce-over
(7) Collision with another vehicle
(8) Other rollover initiation type specify):
(9) Unknown rollover initiation type
60. Location of Rollover Initiation Q
(0) No rollover
(1) On roadway
(2) On shoulder— paved
(3) On shoulder— unpaved
(4) On roadside or divided trafficway median
(9) Unknown
(98) No driver present
(99) Unknown
90
CODES FOR ROLLOVER INITIATION OBJECT CONTACTED
(00) No rollover
(01-30) - Vehicle Number
Noncollision
(31) Turn-over — fall-over
(33) Jackknife
Collision With Fixed Object
(41) Tree (£ 4 inches in diameter)
(42) Tree (> 4 inches in diameter)
(43) Shrubbery or bush
(44) Embankment
(45) Breakaway pole or post (any diameter)
Nonbreakaway Pole or Post
(50) Pole or post (as 4 inches in diameter)
(51) Pole or post (> 4 inches but s 12 inches in
diameter)
(52) Pole 6r post (> 12 inches in diameter)
(53) Pole or post (diameter unknown)
(54) Concrete traffic barrier
(55) Impact attenuator
(56) Other traffic barrier (includes guardrail)
(specify) :
(57) Fence
(58) Wall
(59) Building
(60) Ditch or culvert
(61) Ground
(62) Fire hydrant
(63) Curb
(64) Bridge
(68) Other fixed object (specify):
(69) Unknown fixed object
Collision with Nonfixed Object
(71) Motor vehicle not in-transport
(76) Animal
(77) Train
(78) Trailer, disconnected in transport
(88) Other nonfixed object (specify):
(89) Unknown nonfixed object
(98) Other event (specify):
(99) Unknown event or object
91
National Accident Sampling System-Crashworthiness Data System: General Vehicle Form
Page 6
PRECRASH DATA (Continued)
65.
Critical Precrash Event
Oh.
This Vehicle Loss of Control Due To:
(01 ) Blow out or flat tire
(02) Stalled engine
(03) Disabling vehicle failure (e.g., wheel fell off)
(specify):
(04) Non-disabling vehicle problem (e.g., hood flew
up) (specify):
(05) Poor road conditions (puddle, pot hole, ice, etc.)
(specify):
(06) Traveling too fast for conditions
(08) Other cause of control loss (specify):
(09) Unknown cause of control loss
This Vehicle Traveling
(10) Over the lane line on left side of travel lane
(11) Over the lane line on right side of travel lane
(1 2) Off the edge of the road on the left side
(13) Off the edge of the road on the right side
(14) End departure
(15) Turning left at intersection
(16) Turningjright at intersection
(17) Crossing over (passing through) intersection
(19) Unknown travel direction
Other Motor Vehicle In Lane
(50) Stopped
(51) Traveling in same direction with lower speed
(i.e., lower steady speed or decelerating)
(52) Traveling in same direction with higher speed
(53) Traveling in opposite direction
(54) In crossover
(55) Backing
(59) Unknown travel direction of other motor vehicle
in lane
Other Motor Vehicle Encroaching Into Lane
(60) From adjacent lane (same direction)— over left
lane line
(61) From adjacent lane (same direction)— over right
lane line
(62) From opposite direction— over left lane line
(63) From opposite direction— over right lane line
(64) From parking lane
(65) From crossing street, turning into same
direction
(66) From crossing street, across path
(67) From crossing street, turning into opposite
direction
(68) From crossing street, intended path not known
(70) From driveway, turning into same direction
(71) From driveway, across path
(72) From driveway, turning into opposite direction
(73) From driveway, intended path not known
(74) From entrance to limited access highway
(78) Encroachment by other vehicle— details
unknown
Pedestrian or Pedalcyclist, or Other Nonmotorist
Pedestrian in roadway
Pedestrian approaching roadway
Pedestrian - unknown location
Pedalcyclist or other nonmotorist in roadway
(specify)
(80)
(81)
(82)
(83)
(84)
(85)
Pedalcyclist or other nonmotorist approaching
roadway (specify):
Pedalcyclist or other nonmotorist— unknown
location (specify) i
Object or Animal
(87) Animal in roadway
(88) Animal approaching roadway
(89) Animal— unknown location
(90) Object in roadway
(91) Object approaching roadway
(92) Object— unknown location
(98) Other critical precrash event (specify):
(99) Unknown —
For Corrective Actions Attempted see variable GV14
(Attemped Avoidance Manuever)
66. Precrash Stability After Avoidance Maneuver *-f
(0) No avoidance maneuver
(1) Tracking
(2) Skidding longitudinally— rotation less than 30
degrees
(3) Skidding laterally— clockwise rotation
(4) Skidding laterally— counterclockwise rotation
(7) Other vehicle loss-of -control (specify):
(8) No driver present
(9) Precrash stability unknown
67. Precrash Directional Consequences of _l
Avoidance Maneuver (Corrective Action)
(0) No avoidance maneuver
(1) Vehicle stayed in travel lane where avoidance
maneuver was initiated
(2) Vehicle stayed on roadway but left travel lane
where avoidance maneuver was initiated
(3) Vehicle stayed on roadway, not known if left
travel lane where avoidance maneuver was
initiated
(4) Vehicle departed roadway
(5) Avoidance maneuver initiated off roadway
(8) No driver present
(9) Directional consequences unknown
♦♦♦IF THE CDS APPLICABLE VEHICLE WAS NOT INSPECTED (I.E., GV35 = 0), ♦♦♦
DO NOT COMPLETE THE EXTERIOR AND INTERIOR VEHICLE FORMS.
♦♦♦IF GV07 DOES NOT EQUAL 01-49, DO NOT COMPLETE ♦♦♦
THE EXTERIOR VEHICLE, INTERIOR VEHICLE,
OCCUPANT ASSESSMENT, AND OCCUPANT INJURY FORMS.
92
©
U.S. Department of Transportation
National Highway Traffic Safety
\dmtnbtratk>n
EXTERIOR VEHICLE FORM
NATIONAL ACCIDENT SAMPLING SYSTEM
CRASHWORTHINESS DATA SYSTEM
1 . Primary B ompling Unit Number
2. Case Number - Strotum -
_i_aj__L_a^
3. Vehicle Number
0_L
VEHICLE IDENTIFICATION
Vehicle Make (specify): fo&SS
Model Year ^ (
Vehicle Model (specify): ltj\ r^ouu * UiCTfcfciA
LOCATOR
Locate the end of the damage with respect to the vehicle longitudinal center line or bumper corner for end impacts
or an undamaged axle for side impacts. ,
Specific Impact No.
Location of Direct Damage
£<3T joAfcg.Arrn/C
Location of Field L
CRUSH PROFILE |
NOTES: Identify the plane at which the C-measurements are taken (e.g., at bumper, above bumper, at sill, above
sill, etc.) and label adjustments (e.g., free space).
Measure and document on the vehicle diagram the location of maximum crush.
Measure C1 to C6 from driver to passenger side in front or rear impacts and rear to front in side
impacts.
Free space value is defined as the distance between the baseline and the original body contour taken at
the individual C locations. This may include the following: bumper lead, bumper taper, side protrusion,
side taper, etc. Record the value for each C-measurement and maximum crush.
Use as many lines/columns as necessary to describe each damage profile.
Specific
Impact
Number
Plane of impact
C-Measurements
Direct Damaae
Field
L
c,
c 2
c 3
c 4
c 6
C e
±D
Width
(CDC)
Max
Crush
7
Sr<~C
IM"
21.15''
bo
o
JO.fc>
tS.o"
rXO.D
A<»S
?'§"
+ 5.i
7
(Ittrrci/ae
!*<"
2o.St M
6o
\1>f
3o.il"
At>. P
s.r
^°"
■*s.a>
7
S>(bC£Ai(.
t3.o"
11. o"
S"H
iz.s:
10.-7%
!Z.i>
tU*
—
—
-
HS Form 435A (Rev. 1/92)
93
National Accident Sampling System-Crashworthiness Data System: Exterior Vehicle Form
Page 2
TIRE-WHEEL DAMAGE
a. Rotation physically b. Tire
restricted deflated
RF
LF
RR~3-
LR x.
1_
A.
RF _J_
LF Z
RR ?L
LR 5L
(1) Yes (2) No (8JNA (9) Unk.
TYPE OF TRANSMISSION
D Manual
IS Automatic
VEHICLE DAMAGE SKETCH
ORIGINAL SPECIFICATIONS
Wheelbase
Overall Length
Maximum Width
Curb Weight
Average Track
Front Overhang
Rear Overhang
tt«>r
7?>S r
33^
6*.?s"
Engine Size: cyl./displ. 2/uJ£, / S.%l/db A
Undeformed End Width
WHEEL STEER ANGLES
(For locked front wheels or
displaced rear axles only)
RF ±
LF ±
RR ±
LR ±
o
o
o
o
Within ± 5 degrees
DRIVE WHEELS
□ FWD pi RWD D 4WD
Approximate
Cargo. Weight tooiJLs
PDUOL gQm&MEATT
F£Q*JT £A6 4T&QKC
"TO fHAiH
T
Original
Bumper height
_L
T
(? *-a
, , i
Bumper corner
Stringline
Bumper corner_
Stringline .
d£ovc/rro^
_Bumper corner
Stringline
Q£UA>£ATOfc- ZfvPACT
1 Of *- p AXlX
__ Bumper corner
_1 Stringline
NOTES: Sketch new perimeter end cross hatch direct damage and single hatch induced damage on all views. Annotate observations which might be useful
in reconstructingthe accident (e.g., grass in tire bead, direction of striations, scuff on sidewalls, etc.). If pulling trailer, sketch type of trailer and
damage received on the back of this page.
Annotate any damage caused by extrication such as component removal by torching, prying, or hydraulic shears.
94
National Accident Sampling System-Crashworthiness Data System: Exterior Vehicle Form
CDC WORKSHEET
Page 3
CODES FOR OBJECT CONTACTED
(01-30) — Vehicle Number
Noncollision
(31) Overturn — rollover
(32) Fire or explosion
(33) Jackknife
(34) Other intraunit damage (specify):
(35) Noncollision injury
(38) Other noncollision (specify):
(57) Fence
(58) Wall
(59) Building
(60) Ditch or culvert
(61) Ground
(62) Fire hydrant
(63) Curb
(64) Bridge
(68) Other fixed object (specify):
(39) Noncollision — details unknown
Collision With Fixed Object
(41) Tree (as 4 inches in diameter)
(42) Tree (> 4 inches in diameter)
(43) Shrubbery or bush
(44) Embankment
(45) Breakaway pole or post (any diameter)
Nonbreakaway Pole or Post
(50) Pole or post (£ 4 inches in diameter)
(51) Pole or post (> 4 inches but £ 12 inches in
diameter)
(52) Pole or post (> 12 inches in diameter)
(53) Pole or post (diameter unknown)
(54) Concrete traffic barrier
(55) Impact attenuator
(56) Other traffic barrier (includes guardrail)
(specify) :
(69) Unknown fixed object
Collision with Nonfixed Object
(71 ) Motor vehicle not in-transport
(72) Pedestrian
(73) Cyclist or cycle
(74) Other nonmotorist or conveyance
(75) Vehicle occupant
(76) Animal
(77) Train
(78) Trailer, disconnected in transport
(88) Other nonfixed object (specify):
(89) Unknown nonfixed object
(98) Other event (specify):
(99) Unknown event or object
DEFORMATION CLASSIFICATION BY EVENT NUMBER
Accident
Event
Sequence
Number
Object
Contacted
(1M2)
Direction
of Force
(degrees)
Incremental
Value of
Shift
o \
oj±_
O.S-
OL
o-7
s-o
s~o
43
4 I
H2
HI
M 1
J
S"
O
O
4
o
o
o
o
o
o
o
o
o
o
o
<\
o
o
o
n
o
o
o
o
6
(3)
Deformation
Location
ft.
_^
JL
X-
(4)
Specific
Longitudinal
or Lateral
Location
(6)
Specific
Vertical or
Lateral
Location
G>
P
e
(6)
Type of
Damage
Distribution
±±2_
s
JO
JO
(7)
Deformation
Extent
o \
O 1
_qS
o l
o3
6 a.
o <T
95
National Accident Sampling System-Crashworthiness Data System: Exterior Vehicle Form
COLLISION DEFORMATION CLASSIFICATION
Page 4
HIGHEST DELTA "V
Accident
Event
Sequence Object
Number Contacted
(1X2)
Direction
of Force
(3)
Deformation
Location
(4)
Longitudinal
or Lateral
Location
(5)
Vertical or
Lateral
Location
(6)
Type of
Damage
Distribution
(7)
Deformation
Extent
4. O 7
5. M 3L
6. OO
7._B^
s._e_
9.^.
10. K>
11._Ql.£1
Second Highest Delta "V
12._Q_iT 13. H 3L 14. OO 15. R,
16._£_
17. £
18. Al 19. O 3
CRUSH PROFILE
The crush profile for the damage described in the CDC(s) above should be documented
in the appropriate space below. (ALL MEASUREMENTS ARE IN INCHES.)
HIGHEST DELTA "V"
20.
21.
22.
C,
C 4
C 6
±D
•SlDCRA/c CJto^U
_D_£iL J-L.
Smm+ Highest Delta "V"
23. 24.
L C,
_2_L _J_1 _l2_ _.
25.
C.
C 6
±D
&Ecto*>£ cAO&H
_Q_6 o _q&_ _Li_ _3.o_
^L-CL
_o£_ _DiL
26. Are CDCs Documented
but Not Coded on The
Automated File?
(0) No
(1) Yes
27. Researcher's Assessment
of Vehicle Disposition
(0) Not towed due to
vehicle damage
(1) Towed due to
vehicle damage
(9) Unknown
28. Original Wheelbase
ltH,% Code to the
nearest tenth
of an inch
(9999) Unknown
_LJ_iL--i
96
National Accident Sampling System-Crashworthiness Data System: Exterior Vehicle Form
Page 5
29. Is This A Multi-Stage Manufactured Vehicle
And/Or A Certified Altered Vehicle?
(0) No post manufacturer modifications
(1) Yes - post manufacturer modifications
(specify):
30.
(Include photograph of CERTIFICATION
PLACARD in case report)
(9) Unknown if vehicle is modified
Fire Occurrence
(0) No fire
Yes, fire occurred
(1) Minor
(2) Major
(9) Unknown
O
31. Origin of Fire
(0) No fire
(1) Vehicle exterior (front side, back, top)
(2) Exhaust system
(3) Fuel tank (and other fuel retention
system parts)
(4) Engine compartment
(5) Cargo/trunk compartment
(6) Instrument panel
(7) Passenger compartment area
(8) Other location (specify):
(9) Unknown
32. Type of Fuel Tank
(0) No fuel tank (electrical vehicle)
(1) Metallic
(2) Non-metallic
(9) Unknown
* STOP: IF THE CDS APPLICABLE VEHICLE WAS NOT TOWED AND WAS NOT AN AOPS ###
(I.E., GV09 = OR 9 AND GV36 = 0), DO NOT COMPLETE THE INTERIOR VEHICLE FORM.
97
BEST AVAILABLE COPY
• U^pepartmenj^^
: National H Trafflo Safety
Administration
:'■■■ vV-
;4 \t V^^HSS®
f ^ 4f rimary S a m p lin g i Unft W
:^, Case Tslumbe r Strotum
p ^3. Vehicle Number ^^^
GLAZING
INTEGRITY
£^&fc
P4
isSengef ;
»"«toor*.tohi
i'
dahield end door I
_ dihield •^';w||f
J) Side and rear windov
dtWeld and tkJa wiftdc
and side WindoWl
) ^IftKer combination oFi
w . jfjnknown >t/^^jjl*if|$
fe^^^M^
i^oic^^ht^
l^ezNreontaeted by occupant but no glazing djamafM^^jd:
glazing in place *nd cracked by occupant ^nttie^^^^l ! ^
poor, Tailgate or Hatch ppenii
^^^) |fe!^i^ati| _
^^^M^^o^/pataAort^
^ . ^Door/gate7hatch *
^ili&^^ ^ . , 1MBWW .^
f|jS ^%$) #lozing^^ £y occupy
* "^"^j^iezing "•■■■■**•
r*S^^#iccupai
IfySfclazing disintogra
rP
•'.--: 's^.i^a/feaSias
, : i^>::;i;W^^^-
Damage/Failure Associat
Opening in Collision. « IV05-IV09,** 2, Then code U ^/ J
10. LF_C>1 1. RF_Ol2. LR_Ol3. RR $~>U. TG/H Q
(0) No door/gat or door not opened ,.*£ ^"' ! ; 'k; /: /^k. ^^-^
- - * *•"**-,*. * i f - ;■ J* I . Mt^ 1 * % V 3W ^TO'* 3
Door, Tailgate or Hatch Came Open During Cotlieion ^%f^j^
(1) Door operational tno damageK^^^'-V^i-^St^^^^^
(2) Latch/striker failure duetodai^geT^^^p, ,
(3) Hinge failure due to damage JZ&¥*L ^*S$b&&
; r J4) Door structure failure due t» dairagef^^^^^^j
r : 3*.fl5) '^>oor support (i,a. t .pUlar, .'atlrv oof. side naV^^^^^P^B
. ;'- . '.etc) failure due to damage h^^^^r^$^:^&^^^ 4
16) Latch/striker and hinge failure due to ^damage ^al^ff^f
(8) Other failure (specify): ^.ir i^,;^!;^ f^i ^: ,, ^^,
36,SUl 37/i\oQOOj38,©therJe ,l;:^i
t >c »T|0) 4io glazing contact janoTjio damage, *r no glazing ^C'^ ::.-;- ;
:'&t2) ^%^ : f(^aniparad ;
s^d#r¥
V^ndowPrecrashCiazihg Status
(9) Unknown
'■- <r»,^i-»;«f**"v;
ft JW?
1) Closed
13) Partially opened
> 44) Fully opened ;:
(9) Unknown
*. ?.%" " ' .! - .. * l ?". Js^t'J?' ...»:**a-!l''- .43b&I»£' .*.... ■: . *
mm.
HS Form 435C (Rev. 1/92)
, .' i>it.'rii^a*»'*.'-iW>. ^ .^sC-a
*«* .:i;.wrtirt(i-'Wi-T.wi<^^^"a^aii^'*^^.,^2»?
„. . ^^ jfc ^ r >» ^ . •J a ^t^MMM^ w^to ch. ■ » « tt ■ ■■ fW i ta fc >i &
BEST AVAILABLE COPY
lent Bar
1st?!
MW
'•MM
OCCUPANT AREA INTRUSION
m$m
2&mmmm*t
■I^Pi i^lic^^iSSi^
•*4 -„~-v-:f-T
3s$"f&t# Middle ;:%4
"iLri1'3) ' Righ*l3^^-^<43) ;-«ipht^
•;;«=s.I42) Middle,^
««
••••-Second S«^i*^ 497) Catastrophic v-*. 5 *- .
. ; :fc*2l J Liift jSSSf&t'S^fW) -Other enclosed ivsfc^
" **23)?Rii
^WhlraSeat-^i^^
.- ,i(31i -Left -v-*-*-- .^ r-.: \^r;3stea» - &'3a~- -:-,. ^ ,
133) Rioht C^y
i
-■-£x-.^
MAeNHm>E©F 1NTRMSIOI
31 ) Jfc # inch but *c "43 **
.^•M2)";fc^_4hches but' 4"^B _ „_
■:M4yM$i inches biit 4 v f$afridtikf
4:^(5)^8 jnchesbui J
6)^34 Inches
)JDatastr6|
JL* «!«awKE." Aft* M i^SSHMf *1
!M7f Catastrophic
:\$) Unknown
-• ^2)"Xohoitudinal" '%&&
^3(3) '.lateral .„ :- *^£3C$§
sWph]c:H^!|pl^^^-i; W .
Lfrkitod a^r'a i te^
System:'
92. Steering Kim/Spoke Defor
10) '^No steering \ftfa deformation
H^SM value M"
*6) >« ^ampr.^pt^^^,^ ^--i
(8) Observed deformation cannot be nw
4^»*^y!5^L
m
\mtm
$|05)^i»periia^Mfim/8poke ^-^ -^^
*5i06) J&wer half of rim/spoke
!it07)|IMt liiilf Jdf rim/$poke
^409) ; Complete steering wheel collapse ^
1 410) Undetermined location r, ', > *•&
"499) Unknown - *-' ** • * • '->'**~#*w^
INSTRUMENT PANEL
94. Odometer Reading 7
&^*Lmil
afiaia-miles-Code mileage to the s--*$M
nearest 1*000 miles' ?:i<d>^&f$30%s0™
3000) --No odometerU",^ >i^#\&.1l
4001) "iess than 1,500 miles X ^| ^??
1300) 299,500 miles '-or^morejg^Pfl
J999) Unknown ;^;, T^Jl_ -•ffffi ^g
;Source^tf**-¥*- JV ' ^ "
95/tnstrufrterit1*anel Damage from
Occupant Contact?
10) No . ■'.:';.',:
* ,-,1 -V-, ^.^^V?^ rj " - ^-.^ ^
rjk&j&l
96. Knee Bolster s Deformed from
Occupant Contact?
10) No ^ r.
it) Y«->v^-^*ivr^'^ •■>
. (8) IJot present ^;^%;^;
.1:^4;.:
:**S ;
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ID Yes '-r v _ . -:, : /;\JVC ':
<8) Not present " Mt>-
(9) Unknown VTJ
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seompartment. damage tolbstrumenj panel ;l m^n^^M^ > ^^fl^^^.$W%
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National Accident SamplhiQ Syttam-Crathworthinass Data Syi Interior Vahicla Form
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126) Left side window (lass Including
Jf^§||fame,; window ifli, A pillar, t^>
'*$ pillar, or roof side rail.
»ii«tf4'wwtiw^-^ CODES fOR INTERIOR COMPONENTS
; ;^01 ) Windshield ^ j3H^g&; *
l kjji02\ Mirror -vf ,.-': ^^^^^^
: 404) Steering whsrtfifc '& ! ^t ; ; ' fe 127) Other left aide object Specify): i
i wheel i v|fe : v|y^ "•■:•-: ■ - ^ ■: ■
Left side window sill - v . *
*!*>*'-" ; '*' V'" ; -* -C'V; ;
|£30) flight side interior surface, - y X \v <
: ft?!^^i^c1uding;1iardware"'or armrestr!^^
(48) Child safety seat (specify) :
it^'*^'<
.^|0$) Steering
>406) gwhee ; ; |; *,;£V<28) i*f
#1^ #« $ode* 04 end ^)#>-f* - <" ' **; -V.«^ v *
^07) Steering cokjmr,, jtransmis sion ; ? RIGMT«DE
'^1 ./>" E C -selector Jever, jothsr attachment J
IfJ^W ie.g.rCB, tape
;;? * : deck, air conditioner) V • ' . : " r
J, T 1(09) Left instrument panel and below
(10) Center instrument panel and below
(11) Right instrument panel end below
(12) Glove compartment door
Knee bolster a ■-» 4 ,
Windshield including one or more
of the following: "front header, A-
pillar. Instrument panel, mirror, or
steering assembly (driver side only)
Windshield including one or more
of the following: front header, A-
pillar, instrument panel, or mirror
(passenger side only)
Other front object (specify):
149)
ROOF
\ (BO)
,;;^B2)
#aB53):
^B4)
131) Right side hardware or armrest
(32) Bight A pillar /, - : ^1 £i < * ? SFLOOR
' -^"■ ± -*?r? - 1 * ~-~ Pfy~f** T.r-5fr*T. jeer
(33) *ight B.pillar , w
434) Other right pillar (specify):
(13)
(14)
(15)
(36)
(36)
«7)
Right side window glass or frame
Right side window glass including
one or more of the following: ! s
frame, window sill, A pillar, ^ ■
B pillar, or roof side reil.
Other right side object (specify)::
*56)
(67)
5(68)
169)
Other interior object (specify):
front header W^&j-^* >k - ' ^;
Rear header ,>32#€W :-' ^ '■"•"
Roof left. side tal.^^ V--« ' ^
JRodf right side >a¥ '^"j^&^-r x
Roof or convertible ~tbp "Tj^F ' ^
Floor (including toe pen)
Floor or console mounted : ^ /
transmission lever, including
console ---
Parking brake handle .■■•-->^'.,.
Foot controls including parking
torake' <>•*: ;, v, V. f "> '
(38) Right side window sill
REAR
(60)
(61)
"(62)
(16)
S3fe- :
LEFTSIDE
(20) Left side interior surface/
excluding hardware or armrests
(21 ) Left side hardware or ermrest
(22) Left A pillar
(23) Left B pillar
(24) Other left pillar (specify):
(25) Left side window glass or frame
INTERIOR
(40) Seat, back support V .^ < "J,
(41) Belt restraint webbing/buckle ; -^5
(42) Belt restraint B-pillar , r
;;*i attachment point
(43) Other restraint system component
(specify): ^___
(44) Head restraint system
(45) Air bag
(46) Other occupants (specify):
(47) Interior loose objects
Backlight (rear window) ;
Backlight storage r
Other ■rear, object ; ; (spe^fy);^^^H
CONFIDENCE LEVEL OF ; ;-: „ l
CONTACT POINT I;
(1) Certain -
(2) Probeble r
(3) Possible
(9) Unknown
102
BEST AVAILABLE COPY
BEST AVAILABLE COPY
AUTOMATIC RESTRAINTS
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Automatic (Passive) Salt System ^
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"!T??3} ! Automatic bait use unknown _*.
Automatic (Paaalval Bait Syafam Typa
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(1 ) Non-motorized system ^ - ^ -^ "M^
system ; %
(specify)
(9) Unknown :^&i^
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! ^p^-;.Ocupant Assessment Form^i^fe^^^^^P
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H6) Shoulder belt <lapfeett
destroyed/removed)
(7) Lap belt (shoulder
destroyed/removed)
fipfr^ffei
»(08) ^theV'beltB^ <Bpecify1r;fl: &?# : : / ' ;J
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Shoulder belt used with child safety seat
p J^^ safety)seat :,^
14) ^Lap *n# f hpulder belt used with ctiild
$5) Belt used with child safety seat - ? t ;
HIS) seat
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5J8) Other belt {specify)
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5<9) Unknoyyh -
Manual (A< System Use
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- ^r-(OI) Inoperable lepeclfy): >Tx^'^' •-^^*W-^t'
Manual {Active) Belt failure Modes During Accident
{0) No manual belt used or not available
(1 )'|jp'ii ^^^Svff r ^ ; : -
^2) Torn i^bftl|[ (stretched webbing not v
J3) Broken buckle or latchplate t„ k>;>
, ^ ^v« * /A; : ^ * (*) Upper anchorage separated ^ ^^.j„
u~i* r l ; v^ ^ ; : ^j other anchorage separated (specify): ii „
(02) Shoulder belt
103) Lap belt!
(04) Lap and shoulder belt
(05) Belt used -type unknown
K<**-- : -?>* &K^'C5|>||i^v-(6) Broken retractor ^f^^^^r^^^4-^- ^-.
Si£^ of above {specify):^ ;tf& -\-
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;.il;7XiSWll« v : ; '.: :; (8) -Other manual belt failure {specify):
(9) Unknown
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BEST AVAILABLE COPY
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CHILD SAFETY SEAT FIELD ASSESSMENT
3
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: \I-^i'f|
ItVVhen ;• child safety seat Is present ei
: the occupant's $mperMi
codes listed b«lov
pant Number
ffl&Wi*
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ti
iisAgeVWejght
sfttte) ^>r«*aro facing:,
;^08) ^Other orientatior
' '' ' ' ¥&*■$&$ ' Unknown orientation .Wm&fr
3) Child $af city
s/shield/te _
BsignedlAfith
ess/Shield/Tether * *«** *^*si--<
Jnknown
™ , ji JMk&ear facing ^
f|I|p.2| forward facing
^<^(18) ^thwjirie^atipn
'•^|,^19V Unknown prienta
. . /*ised^f!|ip;
iroess/Shieldnether ■$&*
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'~*~' *"~ Chiid^af^y^eatWlakL _ _ .
^Specify make/imode f nd £ecup
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■T29) ■ Unknbwn orientation ^i^^/^J^&T&Pw.,^
(99) unknown if child safety ^eat used i M\ r "^^^'¥^:^'^' -^ ^>i^ r %
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National Accident Sampling System-Cras hworthiness Data System
worthiness Data System: Interior Vehicle Form X^^^^^4'^ t H9Bf^JM.
m.
HEAD RESTRAINTS/SEAT EVALUATION
NOTES: Encode the applicable data for each seat position in the vehicle- ^he attrlbi
be found at the bottom of the page. Head restraint type/damage and seat type/perf ormance should be
assessed during the vehicle inspection then coded on the Occupant Assessment Form, ^ % ;;;V
1m;
#1 '.;
Head Restraint Type/Damage
Seat Type , *>...'» J f>w^^ft^%
■&»**$&<
Seat Pert on ' ; f.|>#^#^
^Seat Orientati ^ &i^
Left
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Center
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jHead Restraint Type/Damage
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Seat Orientation
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||!ead Bestrairit Type/Damage
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it performance -
^Seat Orientation
T
H
E
R
Head Restraint Type/Damage
Seat Type
Seat Performance
Seat Orientation
Head Restraint Type/Damage by Occupant at This ,
Occupant Position vi , ,
■ . ■" , . "/\<„-' : .- . - - --,- v j^. '■
-■'f-^-^fOK'^o'head.r^rairits --• - v,> ; "' :
(1) Integral — no damage ' ,1 ><■ » a
{2 J Integral — damaged during accident ~=^j^ :
(3) Adjustable — no damage
(4) Adjustable — damaged during accident
(5) Add-on — no damage -
(6) Add-on — damaged during accident
(8) Other Specify):
(9) Unknown ~ —
Seat Type (this Occupant Position)
(00) No seat
(01) Bucket
(02) Bucket with folding back
(03) Bench
(04) Bench with separate back cushions
(05) Bench with folding back(s)
(06) Split bench with separate back cushions
(07) Split bench with folding back(s)
(08) Pedestal (i.e., column supported)
(09) Other seat type (specify):
(10) Box mounted seat (i.e., van type) "
(99) Unknown
Seat Performance (this Occupant Position)
11(0) No seat =
(1) No seat performance failure(s) '
(2) Seat adjusters failed
7^3) Seat back folding locks or "seat back* bailed
specify:_ '' ■• ■--'•:? - "--r
(4) Seat tracks/anchors failed
15) Deformed by impact of occupant '
(6) Deformed by passenger compartment
intrusion (specify):
(7) Combination of above (specify):
(8) Other (specify): ~ ~"
(9) Unknown " - ~
Seat Orientation (this Occupant Position)
(0) No seat
(1) Forward facing seat
(2) Rear facing seat
(3) Side facing seat (inward)
(4) Side facing seat (outward)
(8) Other (specify): < f '^:-* ? :?; -T^:-'
(9) Unknown
DESCRIBE ANY INDICATION OF ABNORMAL OCCUPANT POSTURE (I.E., UNUSUAL OCCUPANT
CONTACT PATTERN)
BEST AVAILABLE COPY
106
^'fpjM^lllljlp
EJECTION/ENTRAPMENT DATA
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antrapment rnc
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APPENDIX D
NASS Occupant Forms
108
©
U.S. Department of Transportation
OCCUPANT ASSESSMENT FORM
Form Approved
O.M.B. No. 2127-0021
National Highway Traffic Safety
Administration
NATIONAL ACCIDENT SAMPLING SYSTEM
CRASHWORTHINESS DATA SYSTEM
1. Primary Sampling Unit Number
2. Case Number - Stratum
3. Vehicle Number
4. Occupant Number
1 *.-
1 1 . Occupant Posture O
(0) Normal posture
(1) Abnormal posture (specify):
l 3l
O I
O l
(9) Unknown
EJECTION/ENTRAPMENT
OCCUPANT'S CHARACTERISTICS
S-JL
Occupant's Age
Code actual age at time of accident.
(00) Less than one year old (specify by month):
(97) 97 years and older
(99) Unknown
6. Occupant's Sex
(1) Male
(2) Female
(9) Unknown
Occupant's Height 70.S" '_5_L
Code actual height to the nearest inch.
(99) Unknown
8. Occupant's Weight ^oJNU* 3L 3l O
Code actual weight to the nearest pounds.
(999) Unknown
9. Occupant's Role
(1) Driver
(2) Passenger
(9) Unknown
10. Occupant's Seat Position
Front Seat
(11) Leftside
(12) Middle
(13) Right side
(14) Other (specify):
(15) On or in the lap of another occupant
12. Ejection
(0) No ejection
(1) Complete ejection
(2) Partial ejection
(3) Ejection, unknown degree
(9) Unknown
13. Ejection Area
(0) No ejection
(1) Windshield
(2) Left front
(3) Right front
(4) Left rear
(5) Right rear
(6) Rear
(7) Roof
(8) Other area (e.g., back of pickup, etc.)
(specify) :
(9) Unknown
o
-L_L
Second Seat
(21) Leftside
(22) Middle
(23) Right side
(24) Other (specify):
(25) On or in the lap ot another occupant
Third Seat
(31) Leftside
(32) Middle
(33) Right side
(34) Other (specify):
(35) On or in the lap of another occupant
Fourth Seat
(41) Leftside
Middle
Right side
Other (specify):
(42)
(43)
(44)
(45)
14. Ejection Medium
(0) No ejection
(1) Door/hatch/tailgate
(2) Nonfixed roof structure
(3) Fixed glazing
(4) Nonfixed glazing (specify):
(5) Integral structure
(8) Other medium (specify):
On or in the lap of another occupant
(97) In or on unenclosed area
(98) Other seat (specify):
(99) Unknown
(9) Unknown
15. Medium Status (Immediately Prior To Impact) O
(0) No ejection
(1) Open
(2) Closed
(3) Integral structure
(9) Unknown
16. Entrapment _
(NOTE: Entrapped means that part of the
person was in the vehicle and mechanically
restrained; jammed doors and immobilizing
injuries by themselves are not sufficient to
constitute entrapment.)
(0) Not entrapped
(1) Entrapped
(9) Unknown
109
HS Form 433 A (1/92)
This report is authorized by P.L. 69-563, Title 1, Section 106, 108, and 112. nin» T vu *re not required to respond,
your cooperation is needed to make the results of this data collection effort comprehensive, accurate, and timely.
National Accident Sampling System-Crashworthiness Data System: Occupant Assessment Form
Page 2
RESTRAINT SYSTEM AND SEAT EVALUATION
17. Manual (Active) Belt System Availability
(0) None available
( 1 ) Belt removed/destroyed
(2) Shoulder belt
(3) Lap belt
(4) Lap and shoulder belt
(5) Belt available— type unknown
Integral Belt Partially Destroyed
(6) Shoulder belt (lap belt destroyed/removed)
(7) Lap belt (shoulder belt destroyed/removed)
(8) Other belt (specify):
(9) Unknown
OH
18. Manual (Active) Belt System Use
(00) None used, not available, or belt
removed/destroyed
(01) Inoperative (specify):
(02) Shoulder belt
(03) Lap belt
(04) Lap and shoulder belt
(05) Belt used— type unknown
(08) Other belt used (specify):
(12) Shoulder belt used with child safety seat
(13) Lap belt used with child safety seat
(14) Lap and shoulder belt used with child
safety seat
(15) Belt used with child safety seat— type unknown
(18) Other belt used with child safety seat
(specify) :
(99) Unknown if belt used
21. Air Bag System Availability /Function
(0) Not equipped/not available
(1) Air bag
Non-functional
(2) Air bag disconnected (specify):
(3) Air bag not reinstalled
(9) Unknown
22. Air Bag System Deployment
(
19. Proper Use of Manual (Active) Belts
(0) None used or not available
(1 ) Belt used properly
(2) Belt used properly with child safety seat
Belt Used Improperly
(3) Shoulder belt worn under arm
(4) Shoulder belt worn behind back or seat
(5) Belt worn around more than one person
(6) Lap belt worn on abdomen
(7) Lap belt or lap and shoulder belt used
improperly with child safety seat (specify):
(8) Other improper use of manual belt system
(specify):
(9) Unknown
20. Manual (Active) Belt Failure Modes
During Accident
(0) No manual belt used
(1) No manual belt failure(s)
(2) Torn webbing (stretched webbing not
included)
(3) Broken buckle or latchplate
(4) Upper anchorage separated
(5) Other anchorage separated (specify):
(6) Broken retractor
(7) Combination of above (specify):
(8) Other manual belt failure (specify):
(9) Unknown
1
(0)
(1)
(2)
(3)
(4)
(5)
(6)
(9)
Not equipped/not available
Air bag deployed during accident (as a
result of impact)
Air bag deployed inadvertently just
prior to accident
Air bag deployed, accident sequence
undetermined
Nondeployed
Unknown if deployed
Air bag deployed as a result of a noncolHsion
event during accident sequence (e.g., fire,
explosion, electrical)
Unknown
23. Did Air Bag System Fail?
(0) Not equipped/not available
(1) No
(2) Yes (specify):
(9) Unknown
Note: See Variables 44 through 48 (Page 5)
for Information on Automatic Belts
24. Police Reported Restraint Use
(0) None used
(1) Police did not indicate restraint use
(2) Shoulder belt
(3) Lap belt
(4) Lap and shoulder belt
(5) Belt used, type not specified
(6) Child safety seat
(7) Other or automatic restraint (specify):
(8) Restrained, type unknown
(9) Police indicated "unknown"
25. Head Restraint Type/Damage by Occupant
at This Occupant Position
(0) No head restraints
(1) Integral— no damage
(2) Integral— damaged during accident
(3) Adjustable— no damage
(4) Adjustable— damaged during accident
(5) Add-on— no damage
(6) Add-on— damaged during accident
(8) Other (specify):
(9) Unknown
110
National Accident Sampling System-Crashworthiness Data System: Occupant Assessment Form
Page 3
26. Seat Type (this Occupant Position)
o 6
(00) Occupant not seated or no seat
(01) Bucket
(02) Bucket with folding back
(03) Bench
(04) Bench with separate back cushions
(05) Bench with folding back(s)
(06) Split bench with separate back cushions
(07) Split bench with folding back(s) p0t» eft >
(08) Pedestal (i.e., column supported)
(09) Other seat type (specify):
(10) Box mounted seat (i.e., van type)
(99) Unknown
27. Seat Performance (this Occupant Position)
(0) Occupant not seated or no seat
(1) No seat performance failure(s)
(2) Seat adjusters failed
(3) Seat back folding locks or "seat back" failed
(4) Seat track/anchors failed
(5) Deformed by impact of occupant
(6) Deformed by passenger compartment intrusion
(specify) :
30. Child Safety Seat Orientation
(00) No child safety seat
O O
(7) Combination of above (specify):
(8) Other (specify):
(9) Unknown
Designed for Rear Facing for This Age/Weight
(01) Rear facing
(02) Forward facing
(08) Other orientation (specify):
(09) Unknown orientation
Designed For Forward Facing for This Age/Weight
(11) Rear facing
(12) Forward facing
(18) Other orientation (specify):
(19) Unknown orientation
Unknown Design or Orientation For This
Age/Weight, or Unknown Age/Weight
(21) Rear facing
(22) Forward facing
(28) Other orientation (specify):
o o
oo
Od
CHILD SAFETY SEAT
o o
28. Child Safety Seat Make/Model
(000) No child safety seat
Applicable codes are found in your NASS CDS
Data Collection, Coding and Editing
(950) Built-in child safety seat
(997) Other make/model (specify):
(998) Unknown make/model
(999) Unknown if child safety seat used
29. Type of Child Safety Seat
(0) No child safety seat
(1) Infant seat
(2) Toddler seat
(3) Convertible seat
(4) Booster seat
(7) Other type child safety seat (specify):
(8) Unknown child safety seat type
(9) Unknown if child safety seat used
(29) Unknown orientation
(99) Unknown if child safety seat used
31 . Child Safety Seat Harness Usage
32. Child Safety Seat Shield Usage
33. Child Safety Seat Tether Usage
Note: Options below applicable to
Variables OA31-OA33.
(00) No child safety seat
Not Designed With Harness/Shield/Tether
(01) After market harness/shield/tether
added, not used
(02) After market harness/shield/tether used
(03) Child safety seat used, but no after market
harness/shield/tether added
(09) Unknown if harness/shield/tether
added or used
Designed With Harness/Shield/Tether
(11) Harness/shield/tether not used
(12) Harness/shield/tether used
(19) Unknown if harness/shield/tether used
Unknown if Designed With Harness/Shield/Tether
(21) Harness/shield/tether not used
(22) Harness/shield/tether used
(29) Unknown if harness/shield/tether used
(99) Unknown if child safety seat used
111
National Accident Sampling System-Crash worthiness Data System: Occupant Assessment Form
Page 4
INJURY CONSEQUENCES
38. Working Days Lost 6 I
Code the number of days
(up through 60) that the occupant
lost from work due to the accident
(00) No working days lost
(61) 61 days or more
(62) Fatally injured
(97) Not working prior to accident
(99) Unknown
39. Time to Death O O
Code number of hours from time of
accident to time of death up through 24
hours. If time of death is greater than 24
hours, code number of days. (Note: 1 day =
31, 2 days - 32, ... n days = 30 +n up through
30 days = 60)
(00) Not fatal
(96) Fatal - ruled disease
(99) Unknown
40. 1st Medically Reported Cause of Death O O
41. 2nd Medically Reported Cause of Death O O
42. 3rd Medically Reported Cause of Death O O
Code the Occupant Injury from line
number(s) for the medically reported
injury(s) which reportedly contributed to
this occupant's death
(00) Not fatal or no additional causes
(97) Other result (specify):
34. Injury Severity (Police Rating) 2l
(0) - No injury
(DC- Possible injury
(2) B - Nonincapacitating injury
(3) A - Incapacitating injury
(4) K - Killed
(5) U - Injury, severity unknown
(6) Died prior to accident
(9) Unknown
35. Treatment - Mortality 3
(0) No treatment
(1) Fatal
(2) Fatal - ruled disease
Nonfatal
(3) Hospitalization
(4) Transported and released
(5) Treatment at scene - nontransported
(6>) Treatment later
(8) Treatment - other (specify):
(9) Unknown
36. Type Of Medical Facility (for Initial Treatment) (
(0) Not treated at a medical facility
(1) Trauma center
(2) Hospital
(3) Medical clinic
(4) Physician's office
(5) Treatment later at medical facility
(8) Other (specify):
(99) Unknown
43. Number of Recorded Injuries for
This Occupant | ^j
Code the actual number of
injuries recorded for this occupant.
(00) No recorded injuries
(97) Injured, details unknown
(99) Unknown if injured
(9) Unknown
37. Hospital Stay 3L 3
(00) Not Hospitalized
Code the number of davs (up through 60)
that the occupant stayed in hospital.
(61) 61 days or more
(99) Unknown
112
National Accident Sampling System-Crash worthiness Data System: Occupant Assessment Form
Page 5
AUTOMATIC BELT SYSTEM
48. Automatic (Passive) Belt Failure Modes O
During Accident
(0) Not equipped/not available/not in use
(1) No automatic belt failure(s)
(2) Torn webbing (stretched webbing not included)
(3) Broken buckle or latchplate
(4) Upper anchorage separated
(5) Other anchorage separated (specify):
44. Automatic (Passive) Belt System Availability/ O
Function
(0) Not equipped/not available
(1)2 point automatic belts
(2) 3 point automatic belts
(3) Automatic belts - type unknown
Non-functional
(4) Automatic belts destroyed or rendered
inoperative
(9) Unknown
45. Automatic (Passive) Belt System Use O
(0) Not equipped/not available/destroyed or
rendered inoperative
(1) Automatic belt in use
(2) Automatic belt not in use (manually
disconnected, motorized track inoperative)
(specify):
(6) Broken retractor
(7) Combination of above (specify):
(8) Other automatic belt failure (specify):
(9) Unknown
49. Seat Orientation (this Occupant Position) \
(0) Occupant not seated or no seat
(1) Forward facing seat
(2) Rear facing seat
(3) Side facing seat (inward)
(4) Side facing seat (outward)
(8) Other (specify):
(3) Automatic belt use unknown
(9) Unknown
46. Automatic (Passive) Belt System Type O
(0) Not equipped/not available
(1) Non-motorized system
(2) Motorized system
(9) Unknown
47. Proper Use of Automatic (Passive Q
Belt System
(0) Not equipped/not available/not used
(1) Automatic belt used properly
(2) Automatic belt used properly with
child safety seat
Automatic Belt Used Improperly
(3) Automatic shoulder belt worn under arm
(4) Automatic shoulder belt worn behind back
(5) Automatic belt worn around more than
one person
(6) Lap portion of automatic belt worn
on abdomen
(7) Automatic lap and shoulder belt or
automatic shoulder belt used improperly
with child safety seat (specify):
(9) Unknown
TRAUMA DATA
50. Glasgow Coma Scale (GCS) Score Q 1_
(at Medical Facility)
(00) Not injured
(01) Injured - not treated at medical facility
(02) No GCS Score at medical facility
(03-1 5) Code the actual value of the
initial GCS Score recorded at medical
facility.
(97) Injured, details unknown
(99) Unknown if injured
51 . Was the Occupant Given Blood? 9
(1) No - blood not given
(2) Yes - blood given
(specify units):
(9) unknown it blood given
52. Arterial Blood Gases (ABG) - HCO-* O [
(00) Not injured
(01) Injured, ABGs not measured or reported
(02-50) Code the actual value of theHCOQ
(96) ABGs reported , HCO3 unknown
(97) Injured, details unknown
(99) Unknown if injured
(8) Other improper use of automatic belt system
(specify):
(9) Unknown
UPDATE CANDIDATE? NO [uT YES [ ]
OCCUPANT INJURY FORM INCLUDED WITH INITIAL SUBMISSION? NO W YES [ ]
*** STOP HERE ***
IF THERE ARE NO RECORDED INJURIES
(I.E., OA43 = 00,97,99)
113
©
U.S. Department of Transportation
National Highway Traffic Safety
Administration
Form Approved
O.M.B. No. 2127-0021
OCCUPANT INJURY FORM NATIONAL ACCIDENT SAMPLING SYSTEM
wwwwi --,■- i i.-wwit i wiiivi CRASHWORTHINESS DATA SYSTEM
1 . Primary Sampling Unit Number
2. Case Number - Stratum
3. Vehicle Number
4. Occupant Number
o \
<\ A- (
Z
INJURY DATA
Record below the actual injuries sustained by this occupant that were identified from the official and unofficial data
sources. Remember not to double count an injury just because it was identified from two different sources. If
greater than ten injuries have been documented, encode the balance on the Occupant Injury Supplement.
O.I.C.-A.I.S
Source _____
of Injury Body
Data Region
Aspect Lesion
System A.I.S.
Organ Severity
Injury
Source Direct/
Injury Confidence Indirect Occupant Area
Source Level injury Intrusion No.
1st 5
WS^^^^^^^^^^M^^M^^^^^S^^^^^^mi
2nd '"^j^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^
II
3rd
i^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^M
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5th
' 46 lill : l*lfi
eth ™§M^
HS Form433B (1/92)
Thia report « authorized by P.L. 89-563, Title 1, Section 106, 108, and 112. While you are not required to respond,
your cooperation is needed to make the results of this data collection effort comprehensive, accurate, and timely.
114
OCCUPANT INJURY DATA
O.I.C.-A.I.S
Source ____^
of Injury Body System A.I.S.
Data Region Aspect Lesion Organ Severity
Injury
Source
Injury
Source Direct/
Confidence Indirect Occupant Area
Level Injury Intrusion No.
11th
£. C, L_ -I. 1- £±
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12th _2_ jy_
SH I \ O
13th ^2 tL 4. JL T j_ 5ll_ _L
O I
14th _^
.a £ i_ s± _l ± _g±
15th
16th
17th
18th
19th
20th
21st
22nd
23rd
24th
25th
115
AGE..&4....
SEX mLE
WT.1220..1bs,
»j T 179. lcm
H T. ^jza^sLi)
Right earlobe laceration
(AIS-1), intruding roof
Superior scalp laceration
(AIS-1), intruding roof
Closed head injury with
brief loss of consciousness
and residual cognitive deficits
Dislocated teeth, #D5-8
(AIS-1) , intruding roof
Non-displaced fracture of the
right zygoma (AIS-2) ,
intruding roof
Right clavicle fracture
(AIS-2) , intruding
right roof side rail
Fractured right ribs 2-g,
with flail chest and
right hemothorax
(AIS-4) , right B-pillar
Right pulmonary
contusion (AIS-3)',
right B-pillar
Comminuted fracture
of the right radial
head (AIS-3) , right
roof side rail
Fracture of the right
proximal ulna (AIS-2) ,
right roof side rail
Displaced nasal fracture (AIS-2) ,
intruding roof
Nasal laceration (AIS-1) ,
intruding roof
T-12 spinous process fracture
(AIS-2) , rebound contact into
seatback/door
Full thickness thermal burn
of the dorsal left middle,
ring and fifth fingers
(AIS-l ) air bag inf lator .
odule
116
SOURCE OF INJURY DATA
OFFICIAL
(1) Autopsy records with or without hospital
medical records
(2) Hospital medical records other than
emergency room (e.g., dishcarge
summary)
(3) Emergency room records only (including
associated X-rays or other lab reports)
(4) Private physician, walk-in or emergency
clinic
UNOFFICIAL
(5)
(6)
(7)
(8)
Lay coroner report
E.M.S. personnel
Interviewee
Other source (specify):
(9) Police
INJURY SOURCE
FRONT
(01) Windshield
(02) Mirror
(03) Sunvisor
(04) Steering wheel rim
(05) Steering wheel hub/spoke
(06) Steering wheel (combination
of codes 04 and 05)
(07) Steering column, transmission
selector lever, other attachment
(08) Add on equipment (e.g., CB, tape
deck, air conditioner)
(09) Left instrument panel and below
(10) Center instrument panel and below
(1 1 ) Right instrument panel and below
(12) Glove compartment door
(13) Knee bolster
(14) Windshield including one or more
of the following: front header. A-
pillar, instrument panel, mirror, or
steering assembly (driver side only)
(15) Windshield including one or more
of the following: front header, A-
pillar, instrument panel, or mirror
(passenger side only)
(1 6) Other front object (specify):
LEFT SIDE
(20) Left side interior surface,
excluding hardware or armrests
(21 ) Left side hardware or armrest
(22) Left A pillar
(23) Left B pillar
(24) Other left pillar (specify):
(25) Left side window glass or frame
(26) Left side window glass including
one or more of the following:
frame, window sill, A-piller,
B-pillar, or roof side rail.
(27) Other left side object (specify):
(28) Left side window sill
RIGHT SIDE
(30) Right side interior surface,
excluding hardware or armrests
(31) Right side hardware or armrest
(32) Right A pillar
(33) Right B pillar
(34) Other right pillar (specify):
(35) Right side window glass or frame
(36) Right side window glass including
one or more of the following:
frame, window sill, A pillar,
B pillar, or roof side rail.
(37) Other right aide object (specify):
(38) Right side window sill
INTERIOR
(40) Seat, back support
(41) Bert restraint webbing/buckle
(42) Belt restraint B-pillar
attachment point
(43) Other restraint system component
(specify):
(44) Head restraint system
(45) Air bag
(46) Other occupants (specify):
(47) Interior loose objects
(48) Child safety seat (specify):
(49) Other interior object (specify):
ROOF
(50) Front header
(51) Rear header
(52) Roof left side rail
(53) Roof right side rail
(54) Roof or convertible top
FLOOR
(56) Floor (including toe pan)
(57) Floor or console mounted
transmission lever, including
console
(58) Parking brake handle
(59) Foot controls including parking
brake
REAR
(60) Backlight (rear window)
O.I.C. Body Region
(M) Abdomen
(Q) Ankle-foot
(A) Arm (upper)
(B) Back-thoracolumbar spine
(C) Chest
(E) Elbow
(F) Face
(R) Forearm
(H) Head-skull
(U) Injured, unknown region
(K) Knee
(L) Leg (lower)
(Y) Lower Kmbs(s) (whole or
unknown part)
(N) Neck— cervical spine
(P) Pelvic-hip
(S) Shoulder
(T) Thigh
(X) Upper Kmb(s) (whole or
unknown part)
(0) Whole body
(W) Wrist-hand
(61) Backlight storage rack, door, etc.
(62) Other rear object (specify):
EXTERIOR of OCCUPANTS VEHICLE
(65) Hood
(66) Outside hardware (e.g., outside
mirror, antenna)
(67) Other exterior surface or tires
(specify) :_
(68) Unknown exterior objects
EXTERIOR OF OTHER MOTOR VEHICLE
(70) Front bumper
(71) Hood edge
(72) Other front of vehicle (specify):
(73) Hood ~~
(74) Hood ornament
(75) Windshield, roof rail, A-pillar
(76) Side surface
(77) Side mirrors
(78) Other side protrusions (specify)
(79) Rear surface
(80) Undercarriage
(81 ) Tires and wheels
(82) Other exterior of other motor vehicle
(specify):
(83) Unknown exterior of other motor vehicle
OTHER VEHICLE OR OBJECT IN THE
ENVIRONMENT
(84) Ground
(85) Other vehicle or object (specify)
(86) Unknown vehicle or object
NONCONTACT INJURY
(90) Fire in vehicle
(91) Flying glass
(92) Other noncontact injury source
(specify):
(93) Air bag exhaust gases
(97) Injured, unknown source
INJURY SOURCE CONFIDENCE
(1) Certain
(2) Probable
(3) Possible
(9) Unknown
DIRECT/INDIRECT INJURY
(1 ) Direct contact injury
(2) Indirect contact injury
(3) Noncontact injury
(7) Injured, unknown source
OCCUPANT INJURY CLASSIFICATION
Aspect of Injury
(A) Anterior— front
(B) Bilateral (rib fracture only)
(C) Central
(I) Inferior— lower
(U) Injured, unknown aspect
(L) Left
(P) Posterior-back
(R) Right
(S) Superior— upper
(W) Whole region
Lesion
(A) Abrasion
(M) Amputation
(V) Avulsion
(B) Bum
(K) Concussion
(C) Contusion
(N) Crush
(G) Detachment, separation
(D) Dislocation
(F) Fracture
(Z) Fracture end dislocation
(U) Injured, unknown lesion
(L) Laceration
(0) Other
(P) Perforation, puncture
(R) Rupture
(S) Sprain
(T) Strain
(E) Total severance, transection
System/Organ
(W) All systems in region
(A) Arteries— veins
(B) Brain
(D) Digestive
(E) Ears
(0) Eye
(H) Heart
(U) Injured, unknown system
(1) Integumentary
(J) Joints
(K) Kidneys
(L) Liver
(M) Muscles
(N) Nervous system
(P) Pulmonary— lungs
(R) Respiratory
(S) Skeletal
(C) Spinal cord
(Q) Spleen
CO Thyroid, other endocrine
gland
(V) Vertebrae
Abbreviated Injury Seals
(1) Minor injury
(2) Moderate injury
(3) Seriour Injury
(4) Severe injury
(5) Critical injury
(6) Maximum (untreatable)
(7) Injured, unknown severity
117
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